Healthcare Provider Details

I. General information

NPI: 1376960310
Provider Name (Legal Business Name): MOUNTAIN REHABILITATION SERVICES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 03/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 KNOX ST
BARBOURVILLE KY
40906-1304
US

IV. Provider business mailing address

702 PHILLIPS LN
CORBIN KY
40701-2144
US

V. Phone/Fax

Practice location:
  • Phone: 606-627-9905
  • Fax: 606-277-0027
Mailing address:
  • Phone: 606-524-4287
  • Fax: 606-862-8517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number005497
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number002081
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA01560
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA02336
License Number StateKY
# 6
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number134657
License Number StateKY

VIII. Authorized Official

Name: JEFFREY GLENN MAGUET
Title or Position: PHYSICAL THERAPIST
Credential:
Phone: 606-524-4287