Provider Demographics
NPI:1306521125
Name:LOLEK NEUROLOGIC REHAB LLC
Entity type:Organization
Organization Name:LOLEK NEUROLOGIC REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUGGEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:419-365-2631
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:MINSTER
Mailing Address - State:OH
Mailing Address - Zip Code:45865-0026
Mailing Address - Country:US
Mailing Address - Phone:419-733-6385
Mailing Address - Fax:
Practice Address - Street 1:86 N HANOVER ST RM 1
Practice Address - Street 2:
Practice Address - City:MINSTER
Practice Address - State:OH
Practice Address - Zip Code:45865-1009
Practice Address - Country:US
Practice Address - Phone:419-733-6385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-19
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy