1033503974 NPI number — COMMONWEALTH THERAPY LOUISVILLE, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033503974 NPI number — COMMONWEALTH THERAPY LOUISVILLE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMONWEALTH THERAPY LOUISVILLE, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033503974
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3703 TAYLORSVILLE RD STE 221
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40220-1331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-592-1736
Provider Business Mailing Address Fax Number:
502-785-4834

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3703 TAYLORSVILLE RD STE 211
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40220-1331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-592-1736
Provider Business Practice Location Address Fax Number:
502-785-4834
Provider Enumeration Date:
03/27/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BRADOW
Authorized Official First Name:
ALLYSON
Authorized Official Middle Name:
Authorized Official Title or Position:
PSYCHOLOGIST/OWNER
Authorized Official Telephone Number:
502-592-1736

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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