Provider Demographics
NPI:1710037544
Name:SPECTRABRACE, LTD
Entity Type:Organization
Organization Name:SPECTRABRACE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, CORPORATE DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:D
Authorized Official - Last Name:TRASK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-244-2774
Mailing Address - Street 1:11802 BRINLEY AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1089
Mailing Address - Country:US
Mailing Address - Phone:502-244-2774
Mailing Address - Fax:502-244-8085
Practice Address - Street 1:500 THOMAS MORE PKWY
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-3454
Practice Address - Country:US
Practice Address - Phone:859-426-1222
Practice Address - Fax:859-426-1222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY240293332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0951590011Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER