Healthcare Provider Details

I. General information

NPI: 1891927315
Provider Name (Legal Business Name): JOSEPHINE LLANORA PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2009
Last Update Date: 08/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 WATERFORD CIR
FRANKFORT KY
40601-7635
US

IV. Provider business mailing address

104 WATERFORD CIR
FRANKFORT KY
40601-7635
US

V. Phone/Fax

Practice location:
  • Phone: 502-875-7382
  • Fax:
Mailing address:
  • Phone: 502-875-7382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number002208
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: