Provider Demographics
NPI:1295936557
Name:1ST PHYSICIAN REHABILITATION, INC.
Entity type:Organization
Organization Name:1ST PHYSICIAN REHABILITATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN.
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:MERSEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-552-1189
Mailing Address - Street 1:1512 CRUMS LN
Mailing Address - Street 2:SUITE #308
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-3861
Mailing Address - Country:US
Mailing Address - Phone:502-471-2390
Mailing Address - Fax:502-471-2393
Practice Address - Street 1:1512 CRUMS LN
Practice Address - Street 2:SUITE #308
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-3861
Practice Address - Country:US
Practice Address - Phone:502-471-2390
Practice Address - Fax:502-471-2393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation