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General NPI Number Information
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NPI Number | 1659558211
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Entity Type | Organization
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Legal Business Name | CENTRAL KENTUCKY REHABILITATION, LLC
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Dates
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Enumeration Date | 01/25/2008
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Last Update Date | 04/14/2008
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Provider Practice Location Address
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Address Line | 255 W MAIN ST SUITE 121
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City | LEBANON
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State | KY
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Zip | 40033-1260
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Country | US
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Telephone | 270-699-2356
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Fax | 270-699-2995
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Provider Business Mailing Address
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Address Line | 255 W MAIN ST SUITE 121
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City | LEBANON
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State | KY
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Zip | 40033-1260
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Country | US
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Telephone | 270-699-2356
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Fax | 270-699-2995
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MR. ERIC MICHAEL MOONEY
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Credential | PT
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Telephone | 270-699-2356
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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 | 004310
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License Number State | KY
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