=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245588946
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHOENIX REHABILITATION AND HEALTH SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2012
-----------------------------------------------------
Last Update Date | 02/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1700 OLD GATESBURG ROAD SUITE 210
-----------------------------------------------------
City | STATE COLLEGE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-278-1912
-----------------------------------------------------
Fax | 814-278-1921
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 392573
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15251-8096
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-343-4060
-----------------------------------------------------
Fax | 724-343-4068
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR, RCM SUPPORT
-----------------------------------------------------
Name | ERIN MCKINNEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 412-339-1063
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC005902L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------