Provider Demographics
NPI:1083765382
Name:BUFFALO RUN PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:BUFFALO RUN PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:FORBES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:879-745-6277
Mailing Address - Street 1:PO BOX 695
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40602-0695
Mailing Address - Country:US
Mailing Address - Phone:502-226-3858
Mailing Address - Fax:502-223-9829
Practice Address - Street 1:3191 BEAUMONT CENTRE CIR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1845
Practice Address - Country:US
Practice Address - Phone:859-223-0101
Practice Address - Fax:859-277-0760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2020-08-22
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
KY1189025OtherCHA
KY000000368088OtherANTHEM BLUE CROSS
KY7019684OtherAETNA
KY000000368088OtherANTHEM BLUE CROSS
KY=========OtherBLUEGRASS FAMILY HEALTH