Healthcare Provider Details

I. General information

NPI: 1477543429
Provider Name (Legal Business Name): LAURIE NEWSOME PT CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 10/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 ABRAHAM FLEXNER WAY SUITE 650
LOUISVILLE KY
40202-1846
US

IV. Provider business mailing address

225 ABRAHAM FLEXNER WAY SUITE 650
LOUISVILLE KY
40202-1846
US

V. Phone/Fax

Practice location:
  • Phone: 502-561-4263
  • Fax: 502-561-4221
Mailing address:
  • Phone: 502-561-4263
  • Fax: 502-561-4221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number000713
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05006654A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License Number000713
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License Number05006654A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: