Provider Demographics
NPI:1114439213
Name:OSPTKY LLC
Entity Type:Organization
Organization Name:OSPTKY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELDON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:502-426-2221
Mailing Address - Street 1:1868 PLAUDIT PL STE B
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2429
Mailing Address - Country:US
Mailing Address - Phone:859-264-0512
Mailing Address - Fax:859-264-0595
Practice Address - Street 1:460 E BRANNON RD
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356
Practice Address - Country:US
Practice Address - Phone:859-887-0599
Practice Address - Fax:859-887-0979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-30
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100489350Medicaid