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	225100000X	Physical Therapist
2	261QP2000X	Physical Therapy Clinic/Center		KY

General Provider Information

NPI Number	:	1972504900
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENTUCKY ORTHOPEDIC REHABILITATION LLC

Provider Business Mailing Address
First Line	:	4714 GETTYSBURG RD
Second Line	:	LEGAL DEPARTMENT
City	:	MECHANICSBURG
State	:	PA
Zip	:	17055-4325
Country	:	US
Telephone Number	:	717-972-1100
Fax Number	:	717-975-9981

Provider Business Practice Location Address
First Line	:	102 WILLIAMS ROAD
Second Line	:
City	:	NICHOLASVILLE
State	:	KY
Zip	:	40356
Country	:	US
Telephone Number	:	859-867-0111
Fax Number	:	859-881-9583

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	JOHN F DUGGAN
Credential	:
Telephone Number	:	717-972-1100

Provider Enumeration Date	:	08/01/2005
Last Update Date	:	10/17/2025

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