Provider Demographics
NPI:1336447267
Name:EISNER, BETH RYAN (PT)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:RYAN
Last Name:EISNER
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 1:409 LOCUST CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-6220
Mailing Address - Country:US
Mailing Address - Phone:502-749-1056
Mailing Address - Fax:
Practice Address - Street 1:409 LOCUST CREEK BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-6220
Practice Address - Country:US
Practice Address - Phone:502-749-1056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2460225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist