Healthcare Provider Details

I. General information

NPI: 1275514564
Provider Name (Legal Business Name): SAINT VINCENT REHAB SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 11/09/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4247 W RIDGE RD STE 104
ERIE PA
16506-1746
US

IV. Provider business mailing address

153 E 13TH ST STE 1300
ERIE PA
16503-1035
US

V. Phone/Fax

Practice location:
  • Phone: 814-338-7249
  • Fax: 814-838-2661
Mailing address:
  • Phone: 814-860-5000
  • Fax: 814-860-5050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: TAMARA L HATT
Title or Position: SR. PROVIDER ENROLLMENT SPECIALIST
Credential:
Phone: 814-452-5772