Provider Demographics
NPI:1437332178
Name:PHOENIX REHAB, LLC
Entity Type:Organization
Organization Name:PHOENIX REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:REX
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAGGEOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-709-7701
Mailing Address - Street 1:136 SAINT MATTHEWS AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3191
Mailing Address - Country:US
Mailing Address - Phone:502-897-1700
Mailing Address - Fax:502-897-1798
Practice Address - Street 1:1600 SCOTTSVILLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3217
Practice Address - Country:US
Practice Address - Phone:207-781-0028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101011261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation