Organization Name: | JEFFERSON COUNTY REHABILITATION |
NPI Number: | 1154445369 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHAEL THOMAS CIBULKA (OWNER) |
Mailing Address: | 1330 Ymca Dr Suite 1200 Festus |
State: | MO US |
Postal Code: | 630282661 |
Phone Number: | 6369317600 |
Fax Number: | 6369318808 |
NPI Enumeration Date: | 03/16/2007 |
NPI Last Update Date: | 09/30/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2000X |
License Number: | 00947 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Physical Therapy |
Taxonomy Definition: |