Cedar Lake Rehabilitation Services

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

100934 Issued in KY

Legal business name

CEDAR LAKE REHABILITATION SERVICES

Practice address

9505 Williamsburg PLZ
Suite 200
Louisville, KY 40222-5082

Phone

(502) 327-7706

NPI assigned

Jun 5, 2015

Last updated

Jun 5, 2015By the provider in NPPES

Organization subpart

Yes

Parent organization

CEDAR LAKE RESIDENCESAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Michelle C Kersting

Title

Director of Financial Services

Phone

(502) 327-7706

Specialties & licenses 3

Addresses

Other identifiers 1

Tax ID family

Cedar Lake Residences Inc2 organizations share this tax ID, including this one

Part of

Cedar Lake Residences Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Cedar Lake Residences, Inc.

  • Developmentally Disabled Services Day Training Agency
  • Louisville, KY
  • NPI 1396947461
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1433462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433462400000",
    "number": "1790165561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9505 WILLIAMSBURG PLZ",
            "address_2": "SUITE 200",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402225082",
            "telephone_number": "502-327-7706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9505 WILLIAMSBURG PLZ",
            "address_2": "SUITE 200",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402225082",
            "telephone_number": "502-327-7706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEDAR LAKE REHABILITATION SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CEDAR LAKE RESIDENCES",
        "enumeration_date": "2015-06-05",
        "last_updated": "2015-06-05",
        "status": "A",
        "authorized_official_last_name": "KERSTING",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCIAL SERVICES",
        "authorized_official_telephone_number": "502-327-7706",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QH0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Hearing and Speech",
            "state": "KY",
            "license": "100934",
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "KY",
            "license": "100934",
            "primary": true
        },
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": "KY",
            "license": "100934",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33900572",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michelle Cecil
• Nathanial Cecil, PHARMD
• Robert A Cecil Jr., P.T.
• Cedar Lake Lodge, Inc.
• Cedar Lake Lodge/Sycamore Run
• Cedar Lake Residences, Inc.
• Cedar Lake Residences, Inc.
• David Thomas Celello, D.M.D.
• Paul C Celestre, MD
• Daven Ceniza

• Physical Therapy Clinic/Center in Louisville, KY
• Providers in Louisville, KY by specialty
• Physical Therapy Clinic/Center in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.