Provider Demographics
NPI:1861580177
Name:REHABILITATION INSTITUTE PLLC
Entity type:Organization
Organization Name:REHABILITATION INSTITUTE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:SWATI
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAFTARY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-495-5055
Mailing Address - Street 1:3103 BRECKENRIDGE LN
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-2798
Mailing Address - Country:US
Mailing Address - Phone:502-495-5055
Mailing Address - Fax:502-495-5057
Practice Address - Street 1:3103 BRECKENRIDGE LN
Practice Address - Street 2:SUITE 1
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-2798
Practice Address - Country:US
Practice Address - Phone:502-495-5055
Practice Address - Fax:502-495-5057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003332363LA2200X
KY30614208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65941684Medicaid
KY009197Medicare PIN
F89739Medicare UPIN