Diversified Rehab Services, LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

DIVERSIFIED REHAB SERVICES, LLC

Practice address

429 S Blanche St
Suite 210
Mounds, IL 62964-1107

Phone

(618) 745-9419

Fax

(618) 745-9421

NPI assigned

Jun 3, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Benjamin N Rice

Title

Owner

Phone

(618) 534-9678

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Elly Nelson, PT

  • Physical Therapist
  • Mounds, IL
  • NPI 1932140720
  Medicare reassignment NPD
• Dewey G Dixon Jr., D.C.

  • Sports Physician Chiropractor
  • Mounds, IL
  • NPI 1215901236
  NPD
• Heather Danette Rice, PAC

  • Physician Assistant
  • Christopher, IL
  • NPI 1700976131
  NPD
• Gordon D Holden, PT

  • Physical Therapist
  • Mounds, IL
  • NPI 1316038938
  NPD (past)
• Julie T Tiu, PT

  • Physical Therapist
  • Marion, IL
  • NPI 1154506228
  NPD (past)
• Joel Christopher Sander, PT

  • Physical Therapist
  • Cape Girardeau, MO
  • NPI 1831211051
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1760420327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 PARK CIR",
            "city": "BENTON",
            "state": "IL",
            "postal_code": "628123464",
            "telephone_number": "618-534-9678",
            "fax_number": "618-435-2346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "429 S BLANCHE ST",
            "address_2": "SUITE 210",
            "city": "MOUNDS",
            "state": "IL",
            "postal_code": "629641107",
            "telephone_number": "618-745-9419",
            "fax_number": "618-745-9421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVERSIFIED REHAB SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RICE",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-534-9678",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cairo Rehab & Fit Fore Golf Inc
• Shakarra Childress
• County of Pulaski
• Delta Center, Inc
• Dixon Chiropractic Center, PC
• Dewey G Dixon Jr., D.C.
• Gordon D Holden, PT
• Integrated Family Health LLC
• Meridian Cusd #101

• Physical Therapy Clinic/Center in Mounds, IL
• Providers in Mounds, IL by specialty
• Physical Therapy Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.