Provider Demographics
NPI:1962036210
Name:EMERGE REHAB & WELLNESS,LLC
Entity Type:Organization
Organization Name:EMERGE REHAB & WELLNESS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST/OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:RAISSA
Authorized Official - Middle Name:JEWELL
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:606-584-9999
Mailing Address - Street 1:3501 FENWICK PARK PL APT F
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-5844
Mailing Address - Country:US
Mailing Address - Phone:606-584-9999
Mailing Address - Fax:
Practice Address - Street 1:3501 FENWICK PARK PL APT F
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-5844
Practice Address - Country:US
Practice Address - Phone:606-584-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-25
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty