Provider Demographics
NPI:1922055524
Name:BELKNAP, MIRIAM DARCY (PT)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:DARCY
Last Name:BELKNAP
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10500 GENTLEWIND CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-4473
Mailing Address - Country:US
Mailing Address - Phone:270-734-1449
Mailing Address - Fax:
Practice Address - Street 1:115 HUSTON DR
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-7250
Practice Address - Country:US
Practice Address - Phone:502-921-0272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2014-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT0013092251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic