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General NPI Number Information
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NPI Number | 1154523132
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Entity Type | Organization
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Legal Business Name | PATIENT FIRST REHABILITATION LLC
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Dates
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Enumeration Date | 06/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10205 HICKORY VALLEY DR
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City | FORT WAYNE
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State | IN
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Zip | 46835-9558
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Country | US
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Telephone | 260-312-0026
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Fax |
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Provider Business Mailing Address
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Address Line | 10205 HICKORY VALLEY DR
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City | FORT WAYNE
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State | IN
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Zip | 46835-9558
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Country | US
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Telephone | 260-312-0026
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Fax |
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Authorized Official
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Title or Position | PT OWNER
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Name | MR. ANDREW T WAGNER
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Credential | PT COMMA ATC
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Telephone | 260-312-0026
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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