Provider Demographics
NPI:1184987331
Name:KENTUCKY PAIN & REHAB LLC
Entity type:Organization
Organization Name:KENTUCKY PAIN & REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:IVEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-454-7444
Mailing Address - Street 1:3715 BARDSTOWN RD STE 312
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-2268
Mailing Address - Country:US
Mailing Address - Phone:502-454-7444
Mailing Address - Fax:
Practice Address - Street 1:3715 BARDSTOWN RD STE 312
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-2268
Practice Address - Country:US
Practice Address - Phone:502-454-7444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy