Healthcare Provider Details

I. General information

NPI: 1063563666
Provider Name (Legal Business Name): COMMONWEALTH REHABILITATION & SPORTS MEDICINE, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5874 VETERANS WAY
BURLINGTON KY
41005-8824
US

IV. Provider business mailing address

PO BOX 911148
LEXINGTON KY
40591-1148
US

V. Phone/Fax

Practice location:
  • Phone: 859-334-4331
  • Fax: 859-586-1798
Mailing address:
  • Phone: 859-278-2121
  • Fax: 859-276-1649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT MCCRAY
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 859-278-2121