Provider Demographics
NPI:1023306669
Name:LIBERTY REHABILITATION PSC
Entity type:Organization
Organization Name:LIBERTY REHABILITATION PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FORREST
Authorized Official - Middle Name:L
Authorized Official - Last Name:WAIDE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:270-824-9227
Mailing Address - Street 1:100 YMCA DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-9000
Mailing Address - Country:US
Mailing Address - Phone:270-824-9227
Mailing Address - Fax:270-824-9206
Practice Address - Street 1:378 US HIGHWAY 62 W
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:KY
Practice Address - Zip Code:42445-2405
Practice Address - Country:US
Practice Address - Phone:270-365-1420
Practice Address - Fax:270-365-1425
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIBERTY REHABILITATION PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHandGroup - Single Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty