Healthcare Provider Details

I. General information

NPI: 1023438249
Provider Name (Legal Business Name): GLEN ALDEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2014
Last Update Date: 04/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N HURSTBOURNE PKWY STE 200
LOUISVILLE KY
40222-5158
US

IV. Provider business mailing address

2531 OLD ROSEBUD RD
LEXINGTON KY
40509-4574
US

V. Phone/Fax

Practice location:
  • Phone: 502-412-5847
  • Fax:
Mailing address:
  • Phone: 859-543-0337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number005172
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: