Provider Demographics
NPI:1285814145
Name:COON, BETH UNDERWOOD (PT, DPT, CHT)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:UNDERWOOD
Last Name:COON
Suffix:
Gender:F
Credentials:PT, DPT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 LYNDON FARM CT STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5005
Mailing Address - Country:US
Mailing Address - Phone:502-882-9379
Mailing Address - Fax:502-805-0526
Practice Address - Street 1:535 MARSAILLES RD
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1911
Practice Address - Country:US
Practice Address - Phone:859-879-3560
Practice Address - Fax:859-879-3564
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0022422251H1200X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20-4579943OtherHUMANA
KY000000540474OtherBCBS
KY611938100OtherUS DEPT OF LABOR WC
KY7311873OtherAETNA
KY20-4579943OtherHUMANA
KY611938100OtherUS DEPT OF LABOR WC