Provider Demographics
NPI:1689903320
Name:KLD THERAPY PLLC
Entity Type:Organization
Organization Name:KLD THERAPY PLLC
Other - Org Name:ACTIVE REHAB AND FITNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:DUERLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:859-797-5513
Mailing Address - Street 1:PO BOX 911063
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40591-1063
Mailing Address - Country:US
Mailing Address - Phone:859-797-5513
Mailing Address - Fax:859-898-0538
Practice Address - Street 1:880 CORPORATE DR STE 202
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-5449
Practice Address - Country:US
Practice Address - Phone:859-797-5513
Practice Address - Fax:859-898-0538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3352225100000X
225100000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty