Healthcare Provider Details

I. General information

NPI: 1013687433
Provider Name (Legal Business Name): PROOF LABORATORIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 SOUTHLAND DR STE 150
LEXINGTON KY
40503-1954
US

IV. Provider business mailing address

208 TWIN SHORES CT
LEXINGTON KY
40515-6403
US

V. Phone/Fax

Practice location:
  • Phone: 859-396-3460
  • Fax: 949-561-5913
Mailing address:
  • Phone: 859-396-3460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. BRADEN PLOWMAN
Title or Position: ELECTROPHYSIOLOGIST
Credential: PT, ECS
Phone: 859-396-3460