Healthcare Provider Details

I. General information

NPI: 1033289459
Provider Name (Legal Business Name): ORTHODYNE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 01/20/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 WELL PARK LANE SUITE 2
CAMPBELLSVILLE KY
42718
US

IV. Provider business mailing address

PO BOX 896
WINCHESTER KY
40392-0896
US

V. Phone/Fax

Practice location:
  • Phone: 270-789-6629
  • Fax:
Mailing address:
  • Phone: 859-737-0904
  • Fax: 859-737-0902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number109-14-4092
License Number StateKY

VIII. Authorized Official

Name: KYLE BRYAN SALSBURY
Title or Position: OWNER
Credential:
Phone: 279-789-6629