Healthcare Provider Details

I. General information

NPI: 1093657868
Provider Name (Legal Business Name): EMMA BLUE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 E 8TH ST
NEW ALBANY IN
47150-3346
US

IV. Provider business mailing address

1312 E 8TH ST
NEW ALBANY IN
47150-3346
US

V. Phone/Fax

Practice location:
  • Phone: 859-421-9199
  • Fax:
Mailing address:
  • Phone: 859-421-9199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberCP030455A
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06006772A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: