Organization
REHAB ON THE ROAD, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH ALLAN MOOK MD, PHD (PHYSICIAN)
(502) 645-1053
Entity
Organization
Contact information
Practice address
800 MAN O WAR BLVD, UNION, KY 41091-8067
(502) 645-1053
(888) 390-7623
Mailing address
800 MAN O WAR BLVD, UNION, KY 41091-8067
(502) 645-1053
(888) 390-7623
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
31321
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000074661
ANTHEM PROVIDER #
KY
01
—
1102772
PASSPORT
KY
01
—
1285608752
NPI
KY
05
—
200179480A
—
IN
01
—
2436318000
PASSPORT ADVANTAGE
KY
01
—
250010583
RAILROAD
KY
05
—
64-313216
—
KY
01
—
P00003391
RAILROAD
IN
Enumeration date
09/30/2008
Last updated
10/17/2012
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