=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376611244
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PERSONALIZED REHAB CONSULTANTS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 NORTH HIGHLAND AVE
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-361-5003
-----------------------------------------------------
Fax | 412-361-7648
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 208 ORANGE STREET
-----------------------------------------------------
City | MONROEVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15146-4127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-952-1447
-----------------------------------------------------
Fax | 412-856-0298
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO PERSONALIZED REHAB CONSULTANTS
-----------------------------------------------------
Name | DIANE LYNNE HOLMES
-----------------------------------------------------
Credential | MPT
-----------------------------------------------------
Telephone | 412-952-1447
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------