Provider Demographics
NPI:1831570399
Name:LOKI INC
Entity type:Organization
Organization Name:LOKI INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:STUMBO
Authorized Official - Suffix:
Authorized Official - Credentials:CSCS
Authorized Official - Phone:606-478-1111
Mailing Address - Street 1:P.O. BOX 68
Mailing Address - Street 2:
Mailing Address - City:BETSY LAYNE
Mailing Address - State:KY
Mailing Address - Zip Code:41605
Mailing Address - Country:US
Mailing Address - Phone:606-478-1111
Mailing Address - Fax:606-478-1113
Practice Address - Street 1:10824 US 23 SOUTH
Practice Address - Street 2:SUITE 102
Practice Address - City:BETSY LAYNE
Practice Address - State:KY
Practice Address - Zip Code:41605
Practice Address - Country:US
Practice Address - Phone:606-478-1111
Practice Address - Fax:606-478-1113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY003789305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY8700057600Medicaid
KY0667503Medicare Oscar/Certification