Provider Demographics
NPI:1053593798
Name:REHAB TO WELLNESS
Entity type:Organization
Organization Name:REHAB TO WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:POTEETE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:513-863-0464
Mailing Address - Street 1:5088 PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-2518
Mailing Address - Country:US
Mailing Address - Phone:513-863-0464
Mailing Address - Fax:513-863-8168
Practice Address - Street 1:5088 PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014
Practice Address - Country:US
Practice Address - Phone:513-863-0464
Practice Address - Fax:513-863-8168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH658111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0327337Medicaid
OH9332681Medicare PIN