=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831308337
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACCESSREHAB INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 708 BARTOL DR # 1
-----------------------------------------------------
City | WARSAW
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46580-4255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-551-1472
-----------------------------------------------------
Fax | 574-268-9493
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 708 BARTOL DR # 1
-----------------------------------------------------
City | WARSAW
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46580-4255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-551-1472
-----------------------------------------------------
Fax | 574-268-9493
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CYNTHIA G ARMENGOL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 574-551-1472
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------