Provider Demographics
NPI:1770024267
Name:SPRINGFIELD PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:SPRINGFIELD PHYSICAL THERAPY, LLC
Other - Org Name:SPRINGFIELD PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAY
Authorized Official - Middle Name:A
Authorized Official - Last Name:CONNOR-ISRAEL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:859-481-9008
Mailing Address - Street 1:PO BOX 265
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:40069-0265
Mailing Address - Country:US
Mailing Address - Phone:859-481-9008
Mailing Address - Fax:859-481-9004
Practice Address - Street 1:1113B LINCOLN PARK RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:KY
Practice Address - Zip Code:40069-9573
Practice Address - Country:US
Practice Address - Phone:859-481-9008
Practice Address - Fax:859-481-9004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100331760Medicaid
KYK078230Medicare UPIN