Healthcare Provider Details

I. General information

NPI: 1255376687
Provider Name (Legal Business Name): KEYSTONE REHABILITATION ASSOCIATES OF WARREN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 06/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8935 E MARKET ST
WARREN OH
44484-2353
US

IV. Provider business mailing address

PO BOX 1245
INDIANA PA
15701-5245
US

V. Phone/Fax

Practice location:
  • Phone: 330-856-9532
  • Fax: 330-856-9622
Mailing address:
  • Phone: 724-465-3496
  • Fax: 215-413-4682

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: MRS. JAYNE FLECK POOL
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 469-467-8705