1184875577 NPI number — ANDERSON PHYSICAL THERAPY LLC

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 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:
Provider Other Organization Name Type Code:
6
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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