Healthcare Provider Details

I. General information

NPI: 1811589807
Provider Name (Legal Business Name): PROREHAB LOUISVILLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6005 TIMBER RIDGE DR
PROSPECT KY
40059-8134
US

IV. Provider business mailing address

PO BOX 5629
EVANSVILLE IN
47716-5629
US

V. Phone/Fax

Practice location:
  • Phone: 502-292-0800
  • Fax: 502-292-0400
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

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