Healthcare Provider Details

I. General information

NPI: 1689453748
Provider Name (Legal Business Name): ACCELERATED PEDIATRIC THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2023
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8838 BOSTON RD
BOSTON KY
40107-8612
US

IV. Provider business mailing address

PO BOX 255
BOSTON KY
40107-0255
US

V. Phone/Fax

Practice location:
  • Phone: 502-507-8739
  • Fax:
Mailing address:
  • Phone: 502-833-8231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIRSTI SMITH
Title or Position: CO-OWNER
Credential: PT, DPT
Phone: 502-507-8739