Healthcare Provider Details

I. General information

NPI: 1114108594
Provider Name (Legal Business Name): APPALACHIAN REHABILITATION TEAM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

464 KY HIGHWAY 699
CORNETTSVILLE KY
41731-8749
US

IV. Provider business mailing address

251 MEDICAL PLAZA LANE STE D
WHITESBURG KY
41858-9323
US

V. Phone/Fax

Practice location:
  • Phone: 606-476-2450
  • Fax: 606-476-2479
Mailing address:
  • Phone: 606-632-1188
  • Fax: 606-632-0075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number002931
License Number StateKY

VIII. Authorized Official

Name: MR. JOHN PHILIP BENTLEY
Title or Position: PRESIDENT
Credential: PT
Phone: 606-632-1188