| NPI | 1164922266 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINA ACOSTA Credentialing Coordinator 859-303-8803 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery |
| 225X00000X Occupational Therapist | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery | |
| 225100000X Physical Therapist | |
| Enumeration Date | 2018-02-15 |
| Last Update Date | 2025-11-19 |