Provider Demographics
NPI:1235876459
Name:GALVEZ, PAULA RAE (PT)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:RAE
Last Name:GALVEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:PAULA
Other - Middle Name:RAE
Other - Last Name:MORTENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4004 ELDER PARK CUTOFF
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-9140
Mailing Address - Country:US
Mailing Address - Phone:502-819-9355
Mailing Address - Fax:
Practice Address - Street 1:4004 ELDER PARK CUTOFF
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014-9140
Practice Address - Country:US
Practice Address - Phone:502-819-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY003871225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist