Healthcare Provider Details

I. General information

NPI: 1689903320
Provider Name (Legal Business Name): KLD THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2009
Last Update Date: 07/11/2023
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 CORPORATE DR STE 202
LEXINGTON KY
40503-5449
US

IV. Provider business mailing address

PO BOX 911063
LEXINGTON KY
40591-1063
US

V. Phone/Fax

Practice location:
  • Phone: 859-797-5513
  • Fax: 859-898-0538
Mailing address:
  • Phone: 859-797-5513
  • Fax: 859-898-0538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3352
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. KEITH ANDREW DUERLER
Title or Position: OWNER
Credential: P.T.
Phone: 859-797-5513