Healthcare Provider Details

I. General information

NPI: 1093273179
Provider Name (Legal Business Name): SHAYNE THOMAS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 GOSS AVE
LOUISVILLE KY
40217-1239
US

IV. Provider business mailing address

1700 ENVOY CIR
LOUISVILLE KY
40299-1822
US

V. Phone/Fax

Practice location:
  • Phone: 502-636-1200
  • Fax: 614-827-0877
Mailing address:
  • Phone: 502-636-1200
  • Fax: 502-636-0351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number008999
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: