Provider Demographics
NPI:1437476744
Name:UPSIDE THERAPEUTIC RIDING, INC
Entity Type:Organization
Organization Name:UPSIDE THERAPEUTIC RIDING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WHEATLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:502-445-8242
Mailing Address - Street 1:250 KENWOOD HILL RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-3535
Mailing Address - Country:US
Mailing Address - Phone:502-445-8242
Mailing Address - Fax:502-363-6240
Practice Address - Street 1:250 KENWOOD HILL RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-3535
Practice Address - Country:US
Practice Address - Phone:502-445-8242
Practice Address - Fax:502-363-6240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY003681225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty