Healthcare Provider Details

I. General information

NPI: 1043655665
Provider Name (Legal Business Name): LANCASTER REHAB & DIAGNOSTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2013
Last Update Date: 05/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2405 N COLUMBUS ST SUITE 140, ROOM D
LANCASTER OH
43130-8185
US

IV. Provider business mailing address

2405 N COLUMBUS ST SUITE 140, ROOM D
LANCASTER OH
43130-8185
US

V. Phone/Fax

Practice location:
  • Phone: 740-687-5025
  • Fax: 740-687-4570
Mailing address:
  • Phone: 740-687-5025
  • Fax: 740-687-4570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DENISE S KORDACK
Title or Position: PRESIDENT/CEO
Credential:
Phone: 740-687-5025