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	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1740385988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENTUCKY ORTHOPEDIC REHABILITATION, LLC

Provider Business Mailing Address
First Line	:	4716 GETTYSBURG RD
Second Line	:
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	:	12613 TAYLORSVILLE RD
Second Line	:	SUITE 118
City	:	LOUISVILLE
State	:	KY
Zip	:	40299-4452
Country	:	US
Telephone Number	:	717-975-4503
Fax Number	:	717-975-9981

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

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	08/22/2020

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