Healthcare Provider Details

I. General information

NPI: 1083434948
Provider Name (Legal Business Name): RWW SENIOR LIVING OUTPATIENT REHAB SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 TRADE ST
TARBORO NC
27886-5025
US

IV. Provider business mailing address

805 N WHITTINGTON PKWY
LOUISVILLE KY
40222-5186
US

V. Phone/Fax

Practice location:
  • Phone: 866-808-4133
  • Fax: 866-849-2728
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: ANGIE MATTINGLY
Title or Position: PROVIDER ENROLLMENT SPECIALIST
Credential:
Phone: 502-630-7494