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General NPI Number Information
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NPI Number | 1699851493
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Entity Type | Organization
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Legal Business Name | PREMIER REHABILITATION SYSTEMS, INC.
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 10/14/2016
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Provider Practice Location Address
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Address Line | 1008 TAVERN RD
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City | MARTINSBURG
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State | WV
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Zip | 25401-2801
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Country | US
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Telephone | 304-264-4040
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Fax | 304-264-4041
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Provider Business Mailing Address
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Address Line | 4660 STATE ROUTE 51 SUITE 2
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City | BELLE VERNON
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State | PA
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Zip | 15012-4305
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Country | US
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Telephone | 724-379-6412
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Fax | 412-592-0939
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Authorized Official
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Title or Position | CORPORATE OFFICER
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Name | STACY RYDBOM
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Credential | PTA
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Telephone | 724-379-6412
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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