Provider Demographics
NPI:1568717445
Name:DERBY CITY REHAB
Entity Type:Organization
Organization Name:DERBY CITY REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:FAITH
Authorized Official - Last Name:MARCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-634-3540
Mailing Address - Street 1:1300 S 4TH ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40208-2314
Mailing Address - Country:US
Mailing Address - Phone:502-634-3540
Mailing Address - Fax:502-634-3566
Practice Address - Street 1:1300 S 4TH ST
Practice Address - Street 2:SUITE 240
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208-2314
Practice Address - Country:US
Practice Address - Phone:502-634-3540
Practice Address - Fax:502-634-3566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty