Healthcare Provider Details

I. General information

NPI: 1407305998
Provider Name (Legal Business Name): PROREHAB LOUISVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 S 15TH ST
LOUISVILLE KY
40210-1319
US

IV. Provider business mailing address

PO BOX 5629
EVANSVILLE IN
47716-5629
US

V. Phone/Fax

Practice location:
  • Phone: 502-890-6900
  • Fax: 502-890-6088
Mailing address:
  • Phone: 812-759-7451
  • Fax: 812-759-7482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAURENCE N BENZ
Title or Position: CEO/OWNER
Credential: DPT
Phone: 502-442-7697