Provider Demographics
NPI:1356834154
Name:OSPTKY LLC
Entity Type:Organization
Organization Name:OSPTKY LLC
Other - Org Name:ORTHOPEDIC & SPORTS PT OF MADISON CO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:WHEELDON
Authorized Official - Suffix:
Authorized Official - Credentials:
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 1:171 N KEENELAND DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-8687
Practice Address - Country:US
Practice Address - Phone:859-575-1888
Practice Address - Fax:859-575-4121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYPENDINGMedicaid