Healthcare Provider Details

I. General information

NPI: 1225061542
Provider Name (Legal Business Name): TOTAL REHAB CENTER, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 03/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 MEDPARK DRIVE
SOMERSET KY
42503-2888
US

IV. Provider business mailing address

175 MEDPARK DRIVE
SOMERSET KY
42503-2888
US

V. Phone/Fax

Practice location:
  • Phone: 606-679-1761
  • Fax: 606-678-0971
Mailing address:
  • Phone: 606-679-1761
  • Fax: 606-678-0971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. TERRY RANDALL
Title or Position: DIRECTOR/OWNER
Credential:
Phone: 606-679-1761