Provider Demographics
NPI:1619535283
Name:ANSETH, SIRI JANE (PT)
Entity Type:Individual
Prefix:
First Name:SIRI
Middle Name:JANE
Last Name:ANSETH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SIRI
Other - Middle Name:JANE
Other - Last Name:ANSETH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5200 COMMERCE CROSSING 3RD FL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229
Mailing Address - Country:US
Mailing Address - Phone:502-861-5278
Mailing Address - Fax:
Practice Address - Street 1:750 CYPRESS STATION DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-5142
Practice Address - Country:US
Practice Address - Phone:502-253-4914
Practice Address - Fax:502-489-5751
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY002722225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist