Healthcare Provider Details

I. General information

NPI: 1689600801
Provider Name (Legal Business Name): PREMIERE REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9505 E 59TH ST SUITE B1
INDIANAPOLIS IN
46216-1025
US

IV. Provider business mailing address

9505 E 59TH ST SUITE B1
INDIANAPOLIS IN
46216-1025
US

V. Phone/Fax

Practice location:
  • Phone: 317-542-7680
  • Fax: 317-542-7682
Mailing address:
  • Phone: 317-542-7680
  • Fax: 317-542-7682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number31003306A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateIN

VIII. Authorized Official

Name: MRS. CHENIN KAE CHESTNUT
Title or Position: MEMBER
Credential: OTR/L
Phone: 317-542-7680