MEDICARE: RWW SENIOR LIVING OUTPATIENT REHAB SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1194545053
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RWW SENIOR LIVING OUTPATIENT REHAB SERVICES, LLC

Provider Business Mailing Address
First Line	:	805 N WHITTINGTON PKWY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-7101
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1860 ATKINSON RD
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30043-5065
Country	:	US
Telephone Number	:	866-808-4133
Fax Number	:	866-849-2728

Authorized Official
Title or Position	:	PROVIDER ENROLLMENT SPECIALIST
Name	:	SARAH ALTSTADT
Credential	:
Telephone Number	:	502-630-7494

Provider Enumeration Date	:	10/15/2024
Last Update Date	:	10/15/2024

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