Provider Demographics
NPI:1114108594
Name:APPALACHIAN REHABILITATION TEAM, INC
Entity Type:Organization
Organization Name:APPALACHIAN REHABILITATION TEAM, INC
Other - Org Name:EAST KENTUCKY PHYSICAL THERAPY AND SPORTS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:BENTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:606-632-1188
Mailing Address - Street 1:251 MEDICAL PLAZA LANE STE D
Mailing Address - Street 2:
Mailing Address - City:WHITESBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41858-9323
Mailing Address - Country:US
Mailing Address - Phone:606-632-1188
Mailing Address - Fax:606-632-0075
Practice Address - Street 1:464 KY HIGHWAY 699
Practice Address - Street 2:
Practice Address - City:CORNETTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41731-8749
Practice Address - Country:US
Practice Address - Phone:606-476-2450
Practice Address - Fax:606-476-2479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY002931225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7488Medicare PIN