Healthcare Provider Details

I. General information

NPI: 1508845868
Provider Name (Legal Business Name): ORTHOCINCY ORTHOPAEDICS & SPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 07/30/2021
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 SOUTH LOOP ROAD
EDGEWOOD KY
41017-5102
US

IV. Provider business mailing address

560 S LOOP RD
EDGEWOOD KY
41017-3405
US

V. Phone/Fax

Practice location:
  • Phone: 859-301-0700
  • Fax: 859-301-0655
Mailing address:
  • Phone: 513-557-4270
  • Fax: 513-557-3214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: JOANN M REIS
Title or Position: CEO/MANAGER
Credential:
Phone: 859-817-7070