Organization
UNIVERSITY REHABILITATION, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK J. GODDARD M.D. (PRESIDENT)
(513) 558-2919
Entity
Organization
Contact information
Practice address
151 W GALBRAITH RD, DRAKE CENTER, CINCINNATI, OH 45216-1015
(513) 418-2707
(513) 418-5838
Mailing address
2830 VICTORY PKWY, CINCINNATI, OH 45206-1785
(513) 245-3617
(513) 475-7259
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
2084N0400X
Neurology Physician
—
—
363A00000X
Physician Assistant
50.000932
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0626175
—
OH
05
—
100011480
—
IN
05
—
2330972
—
OH
05
—
2330981
—
OH
05
—
2330990
—
OH
05
—
2331015
—
OH
05
—
2529393
—
OH
05
—
2529437
—
OH
05
—
2529580
—
OH
05
—
2548121
—
OH
05
—
2609672
—
OH
01
—
50005942
PASSPORT HEALTH PLAN
KY
05
—
65912933
—
KY
Enumeration date
05/01/2006
Last updated
09/24/2010
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