Provider Demographics
NPI:1811232705
Name:WISDOM & HEALTH REHAB CENTRE LLC
Entity Type:Organization
Organization Name:WISDOM & HEALTH REHAB CENTRE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:MORRICE
Authorized Official - Last Name:NANKWENYA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:502-712-1749
Mailing Address - Street 1:4113 BARDSTOWN RD
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-3293
Mailing Address - Country:US
Mailing Address - Phone:502-712-1749
Mailing Address - Fax:502-491-0492
Practice Address - Street 1:4113 BARDSTOWN RD
Practice Address - Street 2:SUITE 101A
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-3293
Practice Address - Country:US
Practice Address - Phone:502-712-1749
Practice Address - Fax:502-491-0492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-03
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY056-06-5458(1)261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy