MEDICARE: ROBERT J POWRIE PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT002453	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT002453	OTHER	KY	STATE LICENSE

General Provider Information

NPI Number	:	1316947013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT J POWRIE PT

Provider Business Mailing Address
First Line	:	PO BOX 950243
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40295-0243
Country	:	US
Telephone Number	:	502-253-1035
Fax Number	:	502-253-1037

Provider Business Practice Location Address
First Line	:	11630 COMMONWEALTH DR
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40299-2300
Country	:	US
Telephone Number	:	502-267-6292
Fax Number	:	502-267-7104

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	12/08/2020

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