MEDICARE: PROMEDICAL REHAB GROUP INC

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
1	174400000X	Specialist	35060023	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2492985	OTHER	AETNA
4	000000039284	OTHER	ANTHEM

General Provider Information

NPI Number	:	1528141132
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROMEDICAL REHAB GROUP INC

Provider Business Mailing Address
First Line	:	1611 27TH ST
Second Line	:	BLDG. J. SUITE202
City	:	PORTSMOUTH
State	:	OH
Zip	:	45662-6931
Country	:	US
Telephone Number	:	740-354-3344
Fax Number	:	740-353-0585

Provider Business Practice Location Address
First Line	:	1611 27TH ST
Second Line	:	BLDG. J. SUITE202
City	:	PORTSMOUTH
State	:	OH
Zip	:	45662-6931
Country	:	US
Telephone Number	:	740-354-3344
Fax Number	:	740-353-0585

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TERRENCE B WELSH
Credential	:	M.D.
Telephone Number	:	740-354-3344

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	12/03/2009

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Directions to “PROMEDICAL REHAB GROUP INC ” Practice Location

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