Provider Demographics
NPI:1033289459
Name:ORTHODYNE, LLC
Entity Type:Organization
Organization Name:ORTHODYNE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:SALSBURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:279-789-6629
Mailing Address - Street 1:PO BOX 896
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40392-0896
Mailing Address - Country:US
Mailing Address - Phone:859-737-0904
Mailing Address - Fax:859-737-0902
Practice Address - Street 1:111 WELL PARK LANE
Practice Address - Street 2:SUITE 2
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718
Practice Address - Country:US
Practice Address - Phone:270-789-6629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY109-14-4092225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty