Organization
PHOENIX REHAB GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRAD NORMAN (ADMINISTRATOR)
(270) 781-0028
Entity
Organization
Contact information
Practice address
1600 SCOTTSVILLE RD, SUITE 101, BOWLING GREEN, KY 42104-3217
(270) 781-0028
(270) 781-0007
Mailing address
PO BOX 391, BOWLING GREEN, KY 42102-0391
(270) 781-0028
(270) 781-0007
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
101011
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000337293
ANTHEM GROUP OT
KY
01
—
000000375294
ANTHEM GROUP SLP
KY
01
—
000000375301
ANTHEM GROUP PT
KY
01
—
2224590
FIRST HEALTH
KY
05
—
87900817
—
KY
05
—
88900071
—
KY
05
—
91000042
—
KY
Enumeration date
01/27/2006
Last updated
04/20/2008
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