Healthcare Provider Details

I. General information

NPI: 1568491496
Provider Name (Legal Business Name): REHAB MEDICAL OF LOUISVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2519 DATA DR
JEFFERSONTOWN KY
40299-2517
US

IV. Provider business mailing address

3750 PRIORITY WAY SOUTH DR
INDIANAPOLIS IN
46240-3831
US

V. Phone/Fax

Practice location:
  • Phone: 502-297-0211
  • Fax: 866-594-5273
Mailing address:
  • Phone: 317-436-6178
  • Fax: 855-671-9194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number263064
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. PATRICK MCGINLEY
Title or Position: PRESIDENT
Credential:
Phone: 317-813-0205