Provider Demographics
NPI:1760976146
Name:PROREHAB INC
Entity Type:Organization
Organization Name:PROREHAB INC
Other - Org Name:PROREHAB OF BOWLING GREEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WEMPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-476-0409
Mailing Address - Street 1:PO BOX 5629
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47716-5629
Mailing Address - Country:US
Mailing Address - Phone:812-759-7476
Mailing Address - Fax:812-773-6365
Practice Address - Street 1:1945 SCOTTSVILLE RD STE A3
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-5855
Practice Address - Country:US
Practice Address - Phone:270-418-3324
Practice Address - Fax:270-418-3326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-19
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY627225100Medicaid