Provider Demographics
NPI:1033568167
Name:PROREHAB OF LOUISVILLE
Entity Type:Organization
Organization Name:PROREHAB OF LOUISVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:502-253-9202
Mailing Address - Street 1:PO BOX 5629
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47716-5629
Mailing Address - Country:US
Mailing Address - Phone:812-401-3259
Mailing Address - Fax:812-401-3259
Practice Address - Street 1:4201 SPRINGHURST BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-6155
Practice Address - Country:US
Practice Address - Phone:502-890-6565
Practice Address - Fax:502-890-6568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-09
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100412360Medicaid
KYK193730OtherMEDICARE