Provider Demographics
NPI:1588619449
Name:PT PROS INC
Entity Type:Organization
Organization Name:PT PROS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:606-526-2918
Mailing Address - Street 1:383 CORBIN CENTER DR
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-1895
Mailing Address - Country:US
Mailing Address - Phone:606-526-2909
Mailing Address - Fax:606-526-2901
Practice Address - Street 1:1138 S HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-3523
Practice Address - Country:US
Practice Address - Phone:606-677-2006
Practice Address - Fax:606-677-1779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7202225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY87900411Medicaid
KY186643OtherCGS ADMIN PART A MEDICARE
KY000000059824OtherBCBS NUMBER