Healthcare Provider Details

I. General information

NPI: 1083765382
Provider Name (Legal Business Name): BUFFALO RUN PHYSICAL THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3191 BEAUMONT CENTRE CIR
LEXINGTON KY
40513-1845
US

IV. Provider business mailing address

PO BOX 695
FRANKFORT KY
40602-0695
US

V. Phone/Fax

Practice location:
  • Phone: 859-223-0101
  • Fax: 859-277-0760
Mailing address:
  • Phone: 502-226-3858
  • Fax: 502-223-9829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: KRIS ALAN FORBES
Title or Position: PRESIDENT
Credential: P.T.
Phone: 879-745-6277