Provider Demographics
NPI:1053535286
Name:UNITED REHABILITATION SERVICES OF GREATER DAYTON
Entity type:Organization
Organization Name:UNITED REHABILITATION SERVICES OF GREATER DAYTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-233-1230
Mailing Address - Street 1:4710 OLD TROY PIKE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45424-5740
Mailing Address - Country:US
Mailing Address - Phone:937-233-1230
Mailing Address - Fax:937-236-8930
Practice Address - Street 1:4710 OLD TROY PIKE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45424-5740
Practice Address - Country:US
Practice Address - Phone:937-233-1230
Practice Address - Fax:937-236-8930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT10492225100000X
OHOT6693225X00000X
OHOT007137225X00000X
OHSP4338235Z00000X
OHSP7843235Z00000X
OHSP8483235Z00000X, 235Z00000X
OHA01234237600000X
OHA00907237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0510772Medicaid
OH000000378664OtherANTHEM INDIVIDUAL NUMBER
OH000000003352OtherANTHEM GROUP NUMBER PT
OH2561508Medicaid
OH000000221897OtherANTHEM GROUP NUMBER
OH000000550569OtherANTHEM INDIVIDUAL NUMBER
OH2561508Medicaid