Healthcare Provider Details

I. General information

NPI: 1871673996
Provider Name (Legal Business Name): RIVERBEND PHYSICAL MEDICINE & REHABILITATION, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 10/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 TRIPLETT ST SUITE 2100
OWENSBORO KY
42303-3104
US

IV. Provider business mailing address

1102 TRIPLETT ST SUITE 2100
OWENSBORO KY
42303-3104
US

V. Phone/Fax

Practice location:
  • Phone: 270-926-7320
  • Fax: 270-926-7302
Mailing address:
  • Phone: 270-926-7320
  • Fax: 270-926-7302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number40170
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number40170
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3007708
License Number StateKY

VIII. Authorized Official

Name: DR. TRISTAN CALDERONE BRIONES II
Title or Position: OWNER
Credential: MD
Phone: 270-926-7320