1083765382 NPI number — BUFFALO RUN PHYSICAL THERAPY, PLLC

Table of content: (NPI 1083765382)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083765382 NPI number — BUFFALO RUN PHYSICAL THERAPY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BUFFALO RUN PHYSICAL THERAPY, 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:
1083765382
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 695
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKFORT
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40602-0695
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-226-3858
Provider Business Mailing Address Fax Number:
502-223-9829

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3191 BEAUMONT CENTRE CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40513-1845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-223-0101
Provider Business Practice Location Address Fax Number:
859-277-0760
Provider Enumeration Date:
01/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FORBES
Authorized Official First Name:
KRIS
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
879-745-6277

Provider Taxonomy Codes

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

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

  • Identifier: 1189025 . This is a "CHA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000368088 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7019684 . This is a "AETNA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com