Healthcare Provider Details

I. General information

NPI: 1457811366
Provider Name (Legal Business Name): TRU ATHLETIC PERFORMANCE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 TAYLORSVILLE RD #5295
LOUISVILLE KY
40255-4011
US

IV. Provider business mailing address

2240 TAYLORSVILLE RD #5295
LOUISVILLE KY
40255-4011
US

V. Phone/Fax

Practice location:
  • Phone: 502-684-3115
  • Fax:
Mailing address:
  • Phone: 502-684-3115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. COURTNEY BROOKE WELLS
Title or Position: OWNER
Credential: DC
Phone: 502-684-3115