Organization
LIBERTY REHABILITATION PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FORREST L WAIDE P.T. (DIRECTOR)
(270) 824-9227
Entity
Organization
Contact information
Practice address
100 YMCA DR, SUITE 5, MADISONVILLE, KY 42431-9000
(270) 824-9227
(270) 824-9206
Mailing address
100 YMCA DR, SUITE 5, MADISONVILLE, KY 42431-9000
(270) 824-9227
(270) 824-9206
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
KY
2251H1200X
Hand Physical Therapist
—
KY
2251X0800X
Orthopedic Physical Therapist
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000477211
ANTHEM FACET GROUP #
KY
Enumeration date
05/25/2006
Last updated
05/13/2012
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