Provider Demographics
NPI:1629140835
Name:DORFLING, MIEMIE A (PT)
Entity Type:Individual
Prefix:
First Name:MIEMIE
Middle Name:A
Last Name:DORFLING
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 BOB O LINK DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3756
Mailing Address - Country:US
Mailing Address - Phone:859-258-8519
Mailing Address - Fax:859-258-8592
Practice Address - Street 1:700 BOB O LINK DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3756
Practice Address - Country:US
Practice Address - Phone:859-258-8519
Practice Address - Fax:859-258-8592
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT-004246225100000X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYASC1019OtherASC MEDICARE GROUP
KYCB5773OtherRR MEDICARE GROUP
KY4000501OtherMEDICARE LAB GROUP
KY36000818OtherASC MEDICAID GROUP
KYP00174738OtherRR PIN NUMBER
KY37903705OtherMEDICAID LAB GROUP
KYASC1019OtherASC MEDICARE GROUP