Provider Demographics
NPI:1003399148
Name:BLUEGRASS REHAB AND MOBILITY
Entity Type:Organization
Organization Name:BLUEGRASS REHAB AND MOBILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:MSOT, OTR/L, ATP
Authorized Official - Phone:502-751-1094
Mailing Address - Street 1:5417 SOUTHERN PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-1327
Mailing Address - Country:US
Mailing Address - Phone:502-751-1094
Mailing Address - Fax:
Practice Address - Street 1:5417 SOUTHERN PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-1327
Practice Address - Country:US
Practice Address - Phone:502-751-1094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1912388109OtherTYPE 1 NPI