Healthcare Provider Details

I. General information

NPI: 1982618393
Provider Name (Legal Business Name): COMMONWEALTH REHABILITATION & SPORTS MEDICINE PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
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: 859-276-6149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

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