Healthcare Provider Details

I. General information

NPI: 1669463170
Provider Name (Legal Business Name): PROFESSIONAL REHABILITATION ASSOCIATES, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 JASON DR STE 5
RICHMOND KY
40475-2785
US

IV. Provider business mailing address

312 JASON DR STE 5
RICHMOND KY
40475-2785
US

V. Phone/Fax

Practice location:
  • Phone: 859-625-0001
  • Fax: 895-625-1109
Mailing address:
  • Phone: 859-625-0001
  • Fax: 895-625-1109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License Number
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateKY

VIII. Authorized Official

Name: MARK E BROOKS
Title or Position: CEO
Credential: PT
Phone: 859-625-0001