Provider Demographics
NPI:1871673996
Name:RIVERBEND PHYSICAL MEDICINE & REHABILITATION, PLLC
Entity Type:Organization
Organization Name:RIVERBEND PHYSICAL MEDICINE & REHABILITATION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRISTAN
Authorized Official - Middle Name:CALDERONE
Authorized Official - Last Name:BRIONES
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:270-926-7320
Mailing Address - Street 1:1102 TRIPLETT ST
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-3104
Mailing Address - Country:US
Mailing Address - Phone:270-926-7320
Mailing Address - Fax:270-926-7302
Practice Address - Street 1:1102 TRIPLETT ST
Practice Address - Street 2:SUITE 2100
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-3104
Practice Address - Country:US
Practice Address - Phone:270-926-7320
Practice Address - Fax:270-926-7302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40170208100000X, 261QM2500X
KY3007708363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty