Provider Demographics
NPI:1801387618
Name:SPROUT THERAPY SERVICES
Entity Type:Organization
Organization Name:SPROUT THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAISPIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:859-803-8890
Mailing Address - Street 1:2083 LAKELYN CT
Mailing Address - Street 2:
Mailing Address - City:CRESCENT SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-4473
Mailing Address - Country:US
Mailing Address - Phone:859-803-8890
Mailing Address - Fax:
Practice Address - Street 1:2083 LAKELYN CT
Practice Address - Street 2:
Practice Address - City:CRESCENT SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:41017-4473
Practice Address - Country:US
Practice Address - Phone:859-803-8890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency