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General NPI Number Information
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NPI Number | 1700159043
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Entity Type | Organization
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Legal Business Name | RECOVERY REHABILITATION 1
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Dates
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Enumeration Date | 02/16/2012
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Last Update Date | 02/16/2012
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Provider Practice Location Address
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Address Line | 2600 W BROADWAY STE 208
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City | LOUISVILLE
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State | KY
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Zip | 40211-1370
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Country | US
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Telephone | 502-742-2300
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Fax | 501-742-2032
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Provider Business Mailing Address
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Address Line | 2600 W BROADWAY STE 208
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City | LOUISVILLE
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State | KY
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Zip | 40211-1370
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Country | US
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Telephone | 502-742-2300
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Fax | 501-742-2032
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEROME JOHANNES
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Credential |
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Telephone | 502-742-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State | KY
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