Basic Information
Provider Information | |||||||||
NPI: | 1831406354 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | PROREHAB OF KENTUCKY, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | KENTUCKY PHYSICAL THERAPY SPECIALISTS | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 5629 | ||||||||
Address2: |   | ||||||||
City: | EVANSVILLE | ||||||||
State: | IN | ||||||||
PostalCode: | 477165629 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8124760409 | ||||||||
FaxNumber: | 8124761016 | ||||||||
Practice Location | |||||||||
Address1: | 1075 N MAIN ST | ||||||||
Address2: |   | ||||||||
City: | MADISONVILLE | ||||||||
State: | KY | ||||||||
PostalCode: | 424311288 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2706435787 | ||||||||
FaxNumber: | 2706430364 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/03/2010 | ||||||||
LastUpdateDate: | 08/11/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | WEMPE | ||||||||
AuthorizedOfficialFirstName: | PATRICK | ||||||||
AuthorizedOfficialMiddleName: | D | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT/OWNER | ||||||||
AuthorizedOfficialTelephone: | 8124760409 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | DPT | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 101106 | KY | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.