Provider Demographics
NPI:1023307592
Name:UNIVERSITY OF LOUISVILLE REHABILITATION FACULTY GROUP, PLLC
Entity type:Organization
Organization Name:UNIVERSITY OF LOUISVILLE REHABILITATION FACULTY GROUP, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HODES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-899-3623
Mailing Address - Street 1:3900 KRESGE WAY
Mailing Address - Street 2:STE #41
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4660
Mailing Address - Country:US
Mailing Address - Phone:502-899-3623
Mailing Address - Fax:502-899-7970
Practice Address - Street 1:3900 KRESGE WAY
Practice Address - Street 2:STE #41
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4660
Practice Address - Country:US
Practice Address - Phone:502-899-3623
Practice Address - Fax:502-899-7970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24102208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty