| Organization Name: | PROREHAB, PC |
| NPI Number: | 1023370475 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DORENE MACK (AR MANAGER) |
| Mailing Address: | 217 E 5th St Eureka |
| State: | MO US |
| Postal Code: | 630251223 |
| Phone Number: | 6365490151 |
| Fax Number: | 6365490152 |
| NPI Enumeration Date: | 06/12/2012 |
| NPI Last Update Date: | 06/12/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |