Provider Demographics
NPI:1386252427
Name:CARDINAL MEDICAL REHABILITATION LLC
Entity type:Organization
Organization Name:CARDINAL MEDICAL REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGGINS
Authorized Official - Suffix:II
Authorized Official - Credentials:PT
Authorized Official - Phone:330-526-6146
Mailing Address - Street 1:3745 WHIPPLE AVE NW STE B
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-4805
Mailing Address - Country:US
Mailing Address - Phone:330-526-6146
Mailing Address - Fax:330-526-6404
Practice Address - Street 1:3745 WHIPPLE AVE NW STE B
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-4805
Practice Address - Country:US
Practice Address - Phone:330-526-6146
Practice Address - Fax:330-526-6404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty