Provider Demographics
NPI:1609210194
Name:PHYSICAL THERAPY PROS LLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY PROS LLC
Other - Org Name:PHYSICAL THERAPY WAY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS
Authorized Official - Phone:270-900-4052
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42702-1559
Mailing Address - Country:US
Mailing Address - Phone:270-900-4052
Mailing Address - Fax:270-900-4054
Practice Address - Street 1:2624 RING RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-9118
Practice Address - Country:US
Practice Address - Phone:270-900-4052
Practice Address - Fax:270-900-4054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-26
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004285261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy