Provider Demographics
NPI:1053512798
Name:THERAPEDS PEDIATRIC PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:THERAPEDS PEDIATRIC PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:TIFFINEY
Authorized Official - Last Name:DEOPERE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:270-402-4546
Mailing Address - Street 1:2024 WINSTON AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-2534
Mailing Address - Country:US
Mailing Address - Phone:270-402-4546
Mailing Address - Fax:
Practice Address - Street 1:2024 WINSTON AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-2534
Practice Address - Country:US
Practice Address - Phone:270-402-4546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY003615225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty