Healthcare Provider Details

I. General information

NPI: 1114649696
Provider Name (Legal Business Name): APTIVA HEALTH SPORTS MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 NEWBURG RD STE 101
LOUISVILLE KY
40218-3368
US

IV. Provider business mailing address

3611 NEWBURG RD STE 101
LOUISVILLE KY
40218-3368
US

V. Phone/Fax

Practice location:
  • Phone: 502-909-0772
  • Fax: 855-859-0123
Mailing address:
  • Phone: 502-909-0772
  • Fax: 855-859-0123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS HUHN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 502-909-0772