| Organization Name: | COMMONWEALTH REHABILITATION AND SPORTS MEDICINE, P.S.C. |
| NPI Number: | 1184670028 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROBERT MCCRAY (CHIEF OPERATING OFFICER) |
| Mailing Address: | 193 Glades Rd Berea |
| State: | KY US |
| Postal Code: | 404031369 |
| Phone Number: | 8599861055 |
| Fax Number: | 8599861002 |
| NPI Enumeration Date: | 05/25/2006 |
| NPI Last Update Date: | 10/04/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |