Provider Demographics
NPI:1356707244
Name:LOUISVILLE PM&R PLLC
Entity type:Organization
Organization Name:LOUISVILLE PM&R PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SWINT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-472-7089
Mailing Address - Street 1:PO BOX 22306
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40252-0306
Mailing Address - Country:US
Mailing Address - Phone:502-963-1905
Mailing Address - Fax:
Practice Address - Street 1:4120 WOODED ACRE LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-2938
Practice Address - Country:US
Practice Address - Phone:502-963-1905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000991965OtherANTHEM
KY50103348OtherPASSPORT HEALTH PLAN
KYDW2736OtherRAILROAD MEDICARE
KY7100397810Medicaid
KYK027131Medicare PIN