Provider Demographics
NPI:1184875577
Name:ANDERSON PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:ANDERSON PHYSICAL THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:BARTH
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-235-1099
Mailing Address - Street 1:401 W MAIN ST STE 2014
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2928
Mailing Address - Country:US
Mailing Address - Phone:502-409-4174
Mailing Address - Fax:502-882-9061
Practice Address - Street 1:3901 DUTCHMANS LANE
Practice Address - Street 2:STE 202
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4799
Practice Address - Country:US
Practice Address - Phone:502-708-2940
Practice Address - Fax:502-708-2942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-04
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00883001OtherMEDICARE GROUP PTAN