Provider Demographics
NPI:1285049668
Name:ROUGH RIVER PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:ROUGH RIVER PHYSICAL THERAPY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:JARBOE
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS
Authorized Official - Phone:270-257-8094
Mailing Address - Street 1:10620 S HIGHWAY 259
Mailing Address - Street 2:
Mailing Address - City:MC DANIELS
Mailing Address - State:KY
Mailing Address - Zip Code:40152-7236
Mailing Address - Country:US
Mailing Address - Phone:270-257-8094
Mailing Address - Fax:
Practice Address - Street 1:10620 S HIGHWAY 259
Practice Address - Street 2:
Practice Address - City:MC DANIELS
Practice Address - State:KY
Practice Address - Zip Code:40152-7236
Practice Address - Country:US
Practice Address - Phone:270-257-8094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-24
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004892225100000X
252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty