Provider Demographics
NPI:1265606222
Name:KORT-KENTUCKY ORTHOPEDIC REHAB TEAM
Entity type:Organization
Organization Name:KORT-KENTUCKY ORTHOPEDIC REHAB TEAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-234-1438
Mailing Address - Street 1:3901 DUTCHMANS LN STE 104
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4726
Mailing Address - Country:US
Mailing Address - Phone:502-899-9927
Mailing Address - Fax:
Practice Address - Street 1:3901 DUTCHMANS LN STE 104
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4726
Practice Address - Country:US
Practice Address - Phone:502-899-9927
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-21
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR2738261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center