Organization
WORKSPORT REHABILITATION SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL BROOKS RPT (PRESIDENT/OWNER)
(574) 231-8950
Entity
Organization
Contact information
Practice address
411 E IRELAND RD STE 400, SOUTH BEND, IN 46614-2681
(574) 231-8950
(574) 231-8955
Mailing address
411 E IRELAND RD STE 400, SOUTH BEND, IN 46614-2681
(574) 231-8950
(574) 231-8955
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
05002570A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000093552
BC BS PROVIDER NUMBER
IN
Enumeration date
10/06/2006
Last updated
08/22/2020
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