Provider Demographics
NPI:1649691676
Name:VIBRANT THERAPY INC
Entity type:Organization
Organization Name:VIBRANT THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GREENWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:270-268-9313
Mailing Address - Street 1:1205 WOODLAND DR
Mailing Address - Street 2:SUITE B 100
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2709
Mailing Address - Country:US
Mailing Address - Phone:270-766-1055
Mailing Address - Fax:270-766-1056
Practice Address - Street 1:1205 WOODLAND DR
Practice Address - Street 2:SUITE B 100
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2709
Practice Address - Country:US
Practice Address - Phone:270-766-1055
Practice Address - Fax:270-766-1056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-17
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR2789225X00000X
KY004036225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty