Provider Demographics
NPI:1700075314
Name:APPALACHIAN REHABILITATION TEAM, INC.
Entity Type:Organization
Organization Name:APPALACHIAN REHABILITATION TEAM, INC.
Other - Org Name:EAST KENTUCKY PHYSICAL THERAPY AND SPORTS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-632-1188
Mailing Address - Street 1:149 MEDICAL PLAZA LANE
Mailing Address - Street 2:SUITE A
Mailing Address - City:WHITESBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41858
Mailing Address - Country:US
Mailing Address - Phone:606-632-1188
Mailing Address - Fax:606-632-0075
Practice Address - Street 1:251 MEDICAL PLAZA LANE
Practice Address - Street 2:SUITE A
Practice Address - City:WHITESBURG
Practice Address - State:KY
Practice Address - Zip Code:41858
Practice Address - Country:US
Practice Address - Phone:606-632-1188
Practice Address - Fax:606-632-0075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA192891Medicare PIN
KY7558Medicare PIN
KY9162Medicare PIN
KY6675Medicare PIN
KY5729Medicare PIN
KY9924Medicare PIN
KY7488Medicare PIN
VAC09676Medicare PIN