Provider Demographics
NPI:1407071921
Name:TOTAL BODY REHAB PLLC
Entity Type:Organization
Organization Name:TOTAL BODY REHAB PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:POWRIE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:502-412-5552
Mailing Address - Street 1:11330 MAPLE BROOK DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241
Mailing Address - Country:US
Mailing Address - Phone:502-412-5552
Mailing Address - Fax:502-412-2234
Practice Address - Street 1:11330 MAPLE BROOK DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241
Practice Address - Country:US
Practice Address - Phone:502-412-5552
Practice Address - Fax:502-412-2234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY002453225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100009380Medicaid
11221868OtherCAQH
KY000000336532OtherANTHEM
KY2686482000OtherPASSPORT ADVANTAGE
KYDE4890OtherRR MEDICARE
KY7100009380Medicaid