Provider Demographics
NPI:1134886658
Name:POWELL, RAVEN LEIGH (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:RAVEN
Middle Name:LEIGH
Last Name:POWELL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9704 HUNTING GROUND CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40228-2481
Mailing Address - Country:US
Mailing Address - Phone:318-201-9919
Mailing Address - Fax:
Practice Address - Street 1:1868 W HEBRON LN UNIT 101
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165
Practice Address - Country:US
Practice Address - Phone:318-201-9919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY008454225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist