Provider Demographics
NPI:1780702860
Name:INDUSTRIAL REHABWORKS PSC
Entity type:Organization
Organization Name:INDUSTRIAL REHABWORKS PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-266-0404
Mailing Address - Street 1:261 RUCCIO WAY STE 190
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3566
Mailing Address - Country:US
Mailing Address - Phone:859-266-0404
Mailing Address - Fax:859-266-0621
Practice Address - Street 1:261 RUCCIO WAY STE 190
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3566
Practice Address - Country:US
Practice Address - Phone:859-266-0404
Practice Address - Fax:859-266-0621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6250Medicare ID - Type Unspecified