| NPI | 1295455202 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TASHANA M PRESTON Billing Director 502-587-1236 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 225100000X Physical Therapist |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2022-08-30 |
| Last Update Date | 2025-02-27 |