MEDICARE: CENTER FOR HOLISTIC HEALING LLC

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	004748	KY

General Provider Information

NPI Number	:	1447648894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR HOLISTIC HEALING LLC

Provider Business Mailing Address
First Line	:	7225 E ORCHARD GRASS BLVD
Second Line	:
City	:	CRESTWOOD
State	:	KY
Zip	:	40014-8561
Country	:	US
Telephone Number	:	502-762-3387
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 LA GRANGE RD
Second Line	:
City	:	PEWEE VALLEY
State	:	KY
Zip	:	40056-9174
Country	:	US
Telephone Number	:	502-290-0694
Fax Number	:	502-242-3088

Authorized Official
Title or Position	:	DOCTOR OF PHYSICAL THERAPY
Name	:	DR. LESLEY B ALLEN
Credential	:	PT, DPT, PYT
Telephone Number	:	502-762-3387

Provider Enumeration Date	:	01/07/2015
Last Update Date	:	02/28/2020

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