Provider Demographics
NPI:1750652327
Name:READ, DONALD MICHAEL (PTA)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:MICHAEL
Last Name:READ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4821 SIMPSON DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-3839
Mailing Address - Country:US
Mailing Address - Phone:502-295-9626
Mailing Address - Fax:
Practice Address - Street 1:4821 SIMPSON DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-3839
Practice Address - Country:US
Practice Address - Phone:502-295-9626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA02430225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant