Provider Demographics
NPI:1104879949
Name:REHAB AT HOME PHYSICAL THERAPY, PLLC
Entity type:Organization
Organization Name:REHAB AT HOME PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SANDI
Authorized Official - Middle Name:MAY
Authorized Official - Last Name:HOLLAR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:607-738-2837
Mailing Address - Street 1:5 HAYES DR
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-1189
Mailing Address - Country:US
Mailing Address - Phone:607-738-2837
Mailing Address - Fax:607-846-3744
Practice Address - Street 1:5 HAYES DR
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-1189
Practice Address - Country:US
Practice Address - Phone:607-738-2837
Practice Address - Fax:607-846-3744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017298225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0605Medicare ID - Type UnspecifiedMEDICARE PART B