Healthcare Provider Details

I. General information

NPI: 1578880381
Provider Name (Legal Business Name): BEE ACTIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 PLEASANT POINTE DR
LEXINGTON KY
40517-4477
US

IV. Provider business mailing address

245 PLEASANT POINTE DR
LEXINGTON KY
40517-4477
US

V. Phone/Fax

Practice location:
  • Phone: 865-809-2483
  • Fax: 859-268-8507
Mailing address:
  • Phone: 865-809-2483
  • Fax: 859-268-8507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT005482
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number005482
License Number StateKY

VIII. Authorized Official

Name: MRS. AMBER NOEL HENDERSON
Title or Position: DOCTORATE OF PHYSICAL THERAPY
Credential: PT,DPT
Phone: 865-809-2483