MEDICARE: DERBY CITY REHAB

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	:	1568717445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DERBY CITY REHAB

Provider Business Mailing Address
First Line	:	1300 S 4TH ST
Second Line	:	SUITE 240
City	:	LOUISVILLE
State	:	KY
Zip	:	40208-2314
Country	:	US
Telephone Number	:	502-634-3540
Fax Number	:	502-634-3566

Provider Business Practice Location Address
First Line	:	1300 S 4TH ST
Second Line	:	SUITE 240
City	:	LOUISVILLE
State	:	KY
Zip	:	40208-2314
Country	:	US
Telephone Number	:	502-634-3540
Fax Number	:	502-634-3566

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JENNIFER FAITH MARCO
Credential	:
Telephone Number	:	502-634-3540

Provider Enumeration Date	:	07/17/2012
Last Update Date	:	07/17/2012

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Directions to “DERBY CITY REHAB ” Practice Location

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