Healthcare Provider Details

I. General information

NPI: 1871927939
Provider Name (Legal Business Name): LKM REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 10/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 EVERSHEAD PL
LOUISVILLE KY
40241-5107
US

IV. Provider business mailing address

PO BOX 22232
LOUISVILLE KY
40252-0232
US

V. Phone/Fax

Practice location:
  • Phone: 502-599-2753
  • Fax: 502-225-9100
Mailing address:
  • Phone: 502-599-2753
  • Fax: 502-225-9100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberPT-005370
License Number StateKY

VIII. Authorized Official

Name: LAURA K MILLER
Title or Position: OWNER
Credential: DPT
Phone: 502-599-2753