Healthcare Provider Details

I. General information

NPI: 1831406354
Provider Name (Legal Business Name): PROREHAB, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2010
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 N MAIN ST
MADISONVILLE KY
42431-1288
US

IV. Provider business mailing address

1650 LYNDON FARM CT STE 300
LOUISVILLE KY
40223-5005
US

V. Phone/Fax

Practice location:
  • Phone: 270-643-5787
  • Fax: 270-643-0364
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 Number101106
License Number StateKY
# 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