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NPI Code Detail

MEDICARE: ERIE SHORES REHABILITATION, LLC

MEDICARE: ERIE SHORES REHABILITATION, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171W00000XContractor
2225100000XPhysical Therapist
3225X00000XOccupational Therapist
4235Z00000XSpeech-Language Pathologist

General Provider Information

NPI Number : 1083832539
Entity Type Code : Organization
Provider Name (Legal Business Name) : ERIE SHORES REHABILITATION, LLC
Provider Business Mailing Address
First Line : 1069 US HIGHWAY 224
Second Line :
City : NOVA
State : OH
Zip : 44859-9770
Country : US
Telephone Number : 419-652-2219
Fax Number : 419-652-2219
Provider Business Practice Location Address
First Line : 1069 US HIGHWAY 224
Second Line :
City : NOVA
State : OH
Zip : 44859-9770
Country : US
Telephone Number : 419-652-2219
Fax Number : 419-652-2219
Authorized Official
Title or Position : PRESIDENT
Name : MR. MATTHEW DAVID MITCHELL
Credential : OTR
Telephone Number : 419-652-2219
Provider Enumeration Date : 04/22/2007
Last Update Date : 09/11/2025

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1164693123 — MRS. JERI R STRAUB PTA
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1871764670 — MS. MARTHA SIEGEL OTR/L
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1225241599 — MRS. LISA L SHEHAN LSW
Practice Location Address:
470 TOWNSHIP ROAD 1101
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Directions to “ERIE SHORES REHABILITATION, LLC ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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