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General NPI Number Information
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NPI Number | 1689727273
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Entity Type | Organization
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Legal Business Name | LAUREL HIGHLANDS NEURO-REHABILITATION
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 07/23/2008
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Provider Practice Location Address
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Address Line | 111A ROOSEVELT BOULEVARD
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City | JOHNSTOWN
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State | PA
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Zip | 15906
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Country | US
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Telephone | 814-619-4223
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Fax | 814-539-0985
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Provider Business Mailing Address
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Address Line | 1086 FRANKLIN ST
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City | JOHNSTOWN
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State | PA
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Zip | 15905-4305
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Country | US
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Telephone | 814-410-8330
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Fax | 814-410-8331
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | LARRY RUTLEDGE
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Credential | PHD
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Telephone | 814-629-4223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TR0400X
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Taxonomy Name | Rehabilitation Psychologist
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License Number | PS008498L
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License Number State | PA
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