1831406354 NPI number — PROREHAB, INC

Table of content: (NPI 1831406354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831406354 NPI number — PROREHAB, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROREHAB, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KENTUCKY PHYSICAL THERAPY SPECIALISTS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831406354
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1650 LYNDON FARM CT STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40223-5005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-401-3258
Provider Business Mailing Address Fax Number:
812-401-3259

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1075 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISONVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42431-1288
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-643-5787
Provider Business Practice Location Address Fax Number:
270-643-0364
Provider Enumeration Date:
09/03/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BAUMANN
Authorized Official First Name:
ANDREA
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
812-759-7473

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X , with the licence number: 101106 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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