Provider Demographics
NPI:1396069514
Name:ULTIMATE REHAB SERVICES
Entity type:Organization
Organization Name:ULTIMATE REHAB SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AMEYA
Authorized Official - Middle Name:RAGHVENDRA
Authorized Official - Last Name:DORSATWAR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:617-784-6396
Mailing Address - Street 1:1099 S MAIN ST
Mailing Address - Street 2:APT 330
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-4851
Mailing Address - Country:US
Mailing Address - Phone:617-784-6396
Mailing Address - Fax:
Practice Address - Street 1:1099 S MAIN ST
Practice Address - Street 2:APT 330
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-4851
Practice Address - Country:US
Practice Address - Phone:617-784-6396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05010049A251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health