Provider Demographics
NPI:1982685814
Name:REHAB ASSOCIATES PSC
Entity Type:Organization
Organization Name:REHAB ASSOCIATES PSC
Other - Org Name:WEITLAUF & VANCE PSC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:VANCE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:270-442-4396
Mailing Address - Street 1:220 BERGER RD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-4522
Mailing Address - Country:US
Mailing Address - Phone:270-442-4396
Mailing Address - Fax:270-442-3346
Practice Address - Street 1:220 BERGER RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-4522
Practice Address - Country:US
Practice Address - Phone:270-442-4396
Practice Address - Fax:270-442-3346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000059161OtherANTHEM GROUP #
KY6577Medicare PIN
KY0049Medicare PIN
KYW78809Medicare UPIN
KY000000059161OtherANTHEM GROUP #
KY0986670001Medicare NSC
KY5678Medicare PIN