Provider Demographics
NPI:1477726909
Name:WESTERN KENTUCKY ORTHOPAEDIC ASSOCIATES REHABILITATION DEPARTMENT
Entity Type:Organization
Organization Name:WESTERN KENTUCKY ORTHOPAEDIC ASSOCIATES REHABILITATION DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:270-793-0395
Mailing Address - Street 1:1777 ASHLEY CIR
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-3339
Mailing Address - Country:US
Mailing Address - Phone:270-793-0395
Mailing Address - Fax:270-793-0765
Practice Address - Street 1:1777 ASHLEY CIR
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3339
Practice Address - Country:US
Practice Address - Phone:270-793-0395
Practice Address - Fax:270-793-0765
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTERN KENTUCKY ORTHOPAEDIC ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT-003526225100000X
KYPT-003058225100000X
KYPT-004206225100000X
KYR2545225X00000X
KYR3434225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty