1184875577 NPI number — ANDERSON PHYSICAL THERAPY LLC

Table of content: (NPI 1184875577)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184875577 NPI number — ANDERSON PHYSICAL THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANDERSON PHYSICAL THERAPY LLC
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:
BACK PAIN RELIEF CENTER, DIABETES CONTROL CENTER
Provider Other Organization Name Type Code:
3
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:
1184875577
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 W MAIN ST STE 2014
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:
40202-2928
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-409-4174
Provider Business Mailing Address Fax Number:
502-882-9061

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3901 DUTCHMANS LANE
Provider Second Line Business Practice Location Address:
STE 202
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207-4799
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-708-2940
Provider Business Practice Location Address Fax Number:
502-708-2942
Provider Enumeration Date:
10/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
ARNOLD
Authorized Official Middle Name:
BARTH
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
502-235-1099

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00883001 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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