Organization
DYLAN RC ENTERPRISES INC
Active
Other names
PRO Rehabilitation Services
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE MITERKO (CREDENTIALING)
(570) 823-7761
Entity
Organization
Contact information
Practice address
693 MAIN ST, NEW MILFORD, PA 18834-7200
(570) 465-2027
(570) 465-2028
Mailing address
1086 HIGHWAY 315 BLVD, WILKES BARRE, PA 18702-7012
(570) 823-7761
(570) 822-8033
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
261QX0100X
Occupational Medicine Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
396759
MEDICARE
PA
Enumeration date
02/11/2021
Last updated
02/11/2021
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