Healthcare Provider Details

I. General information

NPI: 1003086000
Provider Name (Legal Business Name): LIFESPAN PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2412 GREATSTONE PT
LEXINGTON KY
40504-3274
US

IV. Provider business mailing address

2125 PALOMAR TRACE DR
LEXINGTON KY
40513-1120
US

V. Phone/Fax

Practice location:
  • Phone: 859-224-4081
  • Fax: 859-224-4082
Mailing address:
  • Phone: 859-489-0581
  • Fax: 859-224-4082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. ELISA K DILLY
Title or Position: OWNER
Credential: PT, MS, CCM
Phone: 859-489-0581