| NPI | 1881786705 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIDGID M MAHAN Owner 502-899-4760 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 004050) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: KY 004050) |
| 2251S0007X Physical Therapist, Sports (Licence: KY 004050) | |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2015-09-01 |