Healthcare Provider Details

I. General information

NPI: 1902263791
Provider Name (Legal Business Name): PROREHAB LOUISVILLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2016
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 DR ARLA WAY SUITE 102
LOUISVILLE KY
40229-5427
US

IV. Provider business mailing address

PO BOX 5629
EVANSVILLE IN
47716-5629
US

V. Phone/Fax

Practice location:
  • Phone: 502-955-1081
  • Fax: 502-955-1091
Mailing address:
  • Phone: 812-401-3258
  • Fax: 812-401-3259

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 Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANDREA L. BAUMANN
Title or Position: COO
Credential:
Phone: 812-759-7473