Provider Demographics
NPI:1033150438
Name:ORTHOPEDICS PLUS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ORTHOPEDICS PLUS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JASE
Authorized Official - Middle Name:JARED
Authorized Official - Last Name:PINEROLA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:270-726-6640
Mailing Address - Street 1:PO BOX 51426
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-5726
Mailing Address - Country:US
Mailing Address - Phone:270-726-6640
Mailing Address - Fax:270-726-6674
Practice Address - Street 1:105 ROBINS WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-1113
Practice Address - Country:US
Practice Address - Phone:270-726-6640
Practice Address - Fax:270-726-6674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT0019272251E1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, ClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7194Medicare PIN