Healthcare Provider Details

I. General information

NPI: 1306591706
Provider Name (Legal Business Name): PROREHAB LOUISVILLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2022
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 LAFOLLETTE STA N STE 200
FLOYDS KNOBS IN
47119-8747
US

IV. Provider business mailing address

PO BOX 5629
EVANSVILLE IN
47716-5629
US

V. Phone/Fax

Practice location:
  • Phone: 812-940-4240
  • Fax: 812-940-4241
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: ANDREA L. BAUMANN
Title or Position: COO
Credential:
Phone: 812-759-7473