Provider Demographics
NPI:1417213752
Name:ORTHOPEDIC & SPORTS PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:ORTHOPEDIC & SPORTS PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SNIPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-887-0599
Mailing Address - Street 1:460 EAST BRANNON ROAD
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356
Mailing Address - Country:US
Mailing Address - Phone:859-887-0599
Mailing Address - Fax:859-887-0979
Practice Address - Street 1:460 EAST BRANNON ROAD
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?:Yes
Parent Organization LBN:ORTHOPEDIC & SPORTS PHYSICAL THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-11
Last Update Date:2017-02-10
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
KY7100159410Medicaid
KYP100027229Medicare UPIN