Provider Demographics
NPI:1043870785
Name:DRUIN, ELIZABETH SIMONE (LMT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SIMONE
Last Name:DRUIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705 ANDALUSIA LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40272-3303
Mailing Address - Country:US
Mailing Address - Phone:502-974-7602
Mailing Address - Fax:
Practice Address - Street 1:3101 FERN VALLEY RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-3562
Practice Address - Country:US
Practice Address - Phone:502-968-7272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY168502225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist