Healthcare Provider Details

I. General information

NPI: 1740134204
Provider Name (Legal Business Name): SN KENTUCKIANA REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13010 EASTGATE PARK WAY STE 101
LOUISVILLE KY
40223-3984
US

IV. Provider business mailing address

4714 GETTYSBURG RD
MECHANICSBURG PA
17055-4325
US

V. Phone/Fax

Practice location:
  • Phone: 502-244-1210
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: JOHN DUGGAN
Title or Position: CHIEF LEGAL OFFICER
Credential:
Phone: 717-972-1100