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NPI Code Detail

MEDICARE: FUNCTIONAL THERAPY, PLLC

MEDICARE: FUNCTIONAL THERAPY, PLLC
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
1225100000XPhysical Therapist
2235Z00000XSpeech-Language Pathologist
3225X00000XOccupational Therapist

General Provider Information

NPI Number : 1336550136
Entity Type Code : Organization
Provider Name (Legal Business Name) : FUNCTIONAL THERAPY, PLLC
Provider Business Mailing Address
First Line : 1901 COMMONWEALTH CT STE B
Second Line :
City : LOUISVILLE
State : KY
Zip : 40299-2355
Country : US
Telephone Number : 502-458-9978
Fax Number : 502-631-9771
Provider Business Practice Location Address
First Line : 1901 COMMONWEALTH CT STE B
Second Line :
City : LOUISVILLE
State : KY
Zip : 40299-2355
Country : US
Telephone Number : 502-608-7122
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MRS. ANNA M. COBLE
Credential : MS, OTR/L
Telephone Number : 502-608-7122
Provider Enumeration Date : 05/14/2014
Last Update Date : 07/26/2023

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Directions to “FUNCTIONAL THERAPY, PLLC ” Practice Location

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