Provider Demographics
NPI:1194047654
Name:CLV REHABILITATION, PLLC
Entity type:Organization
Organization Name:CLV REHABILITATION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:COLARVSSO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:845-429-5200
Mailing Address - Street 1:105 SOUTH ROUTE 9W
Mailing Address - Street 2:
Mailing Address - City:WEST HAVERSTRAW
Mailing Address - State:NY
Mailing Address - Zip Code:10993
Mailing Address - Country:US
Mailing Address - Phone:845-429-5200
Mailing Address - Fax:845-429-5638
Practice Address - Street 1:105 SOUTH ROUTE 9W
Practice Address - Street 2:
Practice Address - City:WEST HAVERSTRAW
Practice Address - State:NY
Practice Address - Zip Code:10993
Practice Address - Country:US
Practice Address - Phone:845-429-5200
Practice Address - Fax:845-429-5638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022530225100000X
NY025046225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty