Healthcare Provider Details

I. General information

NPI: 1265161012
Provider Name (Legal Business Name): OSPTKY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

474 WHIRLAWAY DR
DANVILLE KY
40422-9037
US

IV. Provider business mailing address

1868 PLAUDIT PL STE B
LEXINGTON KY
40509-2429
US

V. Phone/Fax

Practice location:
  • Phone: 859-238-7650
  • Fax: 859-238-4160
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES J ROTHBAUER
Title or Position: OFFICER
Credential:
Phone: 502-426-2221