Organization
PEDIATRIC REHAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LIBBY ANN BOBO MS (PRESIDENT)
(270) 994-7751
Entity
Organization
Contact information
Practice address
5286 PARKSIDE DR, PADUCAH, KY 42001-7466
(270) 994-7751
Mailing address
5286 PARKSIDE DR, PADUCAH, KY 42001-7466
(270) 994-7751
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
200119099
KY
Other
Enumeration date
06/07/2016
Last updated
06/07/2016
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