Provider Demographics
NPI:1639793300
Name:LOUISVILLE THERAPY GROUP, PLLC
Entity Type:Organization
Organization Name:LOUISVILLE THERAPY GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:ARIDANO
Authorized Official - Suffix:
Authorized Official - Credentials:MSC, CCC-SLP
Authorized Official - Phone:502-501-6789
Mailing Address - Street 1:2618 PINDELL AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-2322
Mailing Address - Country:US
Mailing Address - Phone:502-501-6789
Mailing Address - Fax:
Practice Address - Street 1:2618 PINDELL AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-2322
Practice Address - Country:US
Practice Address - Phone:502-501-6789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty