MEDICARE: KENTUCKY ORTHOPEDIC REHABILITATION 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1700094778
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENTUCKY ORTHOPEDIC REHABILITATION LLC

Provider Business Mailing Address
First Line	:	4716 GETTYSBURG RD
Second Line	:	LEGAL DEPARTMENT
City	:	MECHANICSBURG
State	:	PA
Zip	:	17055-4325
Country	:	US
Telephone Number	:	717-975-4503
Fax Number	:	717-975-9981

Provider Business Practice Location Address
First Line	:	3901 DUTCHMANS LN
Second Line	:	SUITE 104
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-4722
Country	:	US
Telephone Number	:	502-899-9927
Fax Number	:	502-899-5810

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MICHAEL TARVIN
Credential	:
Telephone Number	:	717-975-4503

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	03/14/2008

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