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General NPI Number Information
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NPI Number | 1184987331
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Entity Type | Organization
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Legal Business Name | KENTUCKY PAIN & REHAB LLC
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Dates
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Enumeration Date | 06/22/2012
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Last Update Date | 06/22/2012
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Provider Practice Location Address
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Address Line | 3715 BARDSTOWN RD STE 312
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City | LOUISVILLE
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State | KY
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Zip | 40218-2268
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Country | US
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Telephone | 502-454-7444
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Fax |
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Provider Business Mailing Address
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Address Line | 3715 BARDSTOWN RD STE 312
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City | LOUISVILLE
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State | KY
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Zip | 40218-2268
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Country | US
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Telephone | 502-454-7444
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. DAVID IVEY
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Credential | DC
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Telephone | 502-454-7444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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