Healthcare Provider Details

I. General information

NPI: 1962839845
Provider Name (Legal Business Name): WELLNESS MEDICAL AND REHABILITATION CENTER,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2013
Last Update Date: 11/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4229 BARDSTOWN RD
LOUISVILLE KY
40218-3241
US

IV. Provider business mailing address

4229 BARDSTOWN RD
LOUISVILLE KY
40218-3241
US

V. Phone/Fax

Practice location:
  • Phone: 502-499-4156
  • Fax: 502-499-4170
Mailing address:
  • Phone: 502-499-4156
  • Fax: 502-499-4170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number39869
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number36067
License Number StateKY

VIII. Authorized Official

Name: DR. ARLES PERDOMO
Title or Position: PRESIDENT
Credential: M.D
Phone: 502-499-4156