Provider Demographics
NPI:1851627244
Name:MOUNTAIN REHABILITATION SERVICES, LLC
Entity Type:Organization
Organization Name:MOUNTAIN REHABILITATION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:GLEN
Authorized Official - Last Name:MAGUET
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:606-524-4287
Mailing Address - Street 1:702 PHILLIPS LN
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-2144
Mailing Address - Country:US
Mailing Address - Phone:606-524-4287
Mailing Address - Fax:
Practice Address - Street 1:702 PHILLIPS LN
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-2144
Practice Address - Country:US
Practice Address - Phone:606-524-4287
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY002081225100000X
KY005497225100000X
KYA01560225200000X
KYA01938225200000X
KYA02336225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty