Provider Demographics
NPI:1063563666
Name:COMMONWEALTH REHABILITATION & SPORTS MEDICINE, PSC
Entity type:Organization
Organization Name:COMMONWEALTH REHABILITATION & SPORTS MEDICINE, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-278-2121
Mailing Address - Street 1:PO BOX 911148
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40591-1148
Mailing Address - Country:US
Mailing Address - Phone:859-278-2121
Mailing Address - Fax:859-276-1649
Practice Address - Street 1:5874 VETERANS WAY
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:KY
Practice Address - Zip Code:41005-8824
Practice Address - Country:US
Practice Address - Phone:859-334-4331
Practice Address - Fax:859-586-1798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty