Healthcare Provider Details

I. General information

NPI: 1700873809
Provider Name (Legal Business Name): KETTERING REHABILITATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 LEITER RD
MIAMISBURG OH
45342-3660
US

IV. Provider business mailing address

PO BOX 750245
DAYTON OH
45475-0245
US

V. Phone/Fax

Practice location:
  • Phone: 937-384-8797
  • Fax: 937-384-8716
Mailing address:
  • Phone: 937-438-9500
  • Fax: 937-438-9075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number35042424B
License Number StateOH

VIII. Authorized Official

Name: DR. DANIEL BRAUNLIN
Title or Position: PRESIDENT
Credential: MD
Phone: 937-384-8797