Provider Demographics
NPI:1487781530
Name:MOBILE REHAB,LLC
Entity type:Organization
Organization Name:MOBILE REHAB,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-881-4444
Mailing Address - Street 1:1060 ELIZABETH DR
Mailing Address - Street 2:SUITE # 1
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-9527
Mailing Address - Country:US
Mailing Address - Phone:859-881-4444
Mailing Address - Fax:
Practice Address - Street 1:1060 ELIZABETH DR
Practice Address - Street 2:SUITE # 1
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-9527
Practice Address - Country:US
Practice Address - Phone:859-881-4444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90008400Medicaid
KY90008400Medicaid