Healthcare Provider Details

I. General information

NPI: 1902668841
Provider Name (Legal Business Name): REWIND MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2024
Last Update Date: 01/26/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4384 CLEARWATER WAY STE 190
LEXINGTON KY
40515-6493
US

IV. Provider business mailing address

113 GLENN PL
LEXINGTON KY
40505-3518
US

V. Phone/Fax

Practice location:
  • Phone: 859-403-3385
  • Fax: 859-687-6144
Mailing address:
  • Phone: 859-396-5934
  • Fax: 859-687-6144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. JORDAN PALMER
Title or Position: PRESIDENT
Credential:
Phone: 859-534-8550