Provider Demographics
NPI:1073280145
Name:IN HIS IMAGE LLC
Entity Type:Organization
Organization Name:IN HIS IMAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDRIA
Authorized Official - Middle Name:TATE HANKS
Authorized Official - Last Name:SOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:270-791-0613
Mailing Address - Street 1:630 WEDGEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-1448
Mailing Address - Country:US
Mailing Address - Phone:270-791-0613
Mailing Address - Fax:
Practice Address - Street 1:630 WEDGEWOOD CIR
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-1448
Practice Address - Country:US
Practice Address - Phone:270-791-0613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-26
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty