Provider Demographics
NPI:1063506194
Name:BLUEGRASS PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:BLUEGRASS PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:FIELDS
Authorized Official - Last Name:ELSWICK
Authorized Official - Suffix:
Authorized Official - Credentials:PT, OCS
Authorized Official - Phone:859-253-9953
Mailing Address - Street 1:2600 GRIBBIN DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-4498
Mailing Address - Country:US
Mailing Address - Phone:859-268-8190
Mailing Address - Fax:859-268-9823
Practice Address - Street 1:2600 GRIBBIN DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-4498
Practice Address - Country:US
Practice Address - Phone:859-268-8190
Practice Address - Fax:859-268-9823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY8173Medicare ID - Type Unspecified