Healthcare Provider Details

I. General information

NPI: 1508346834
Provider Name (Legal Business Name): ASSOCAITES IN PEDIATRIC THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2018
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1927 LEWISTON DR
LOUISVILLE KY
40216-2523
US

IV. Provider business mailing address

90 HOWARD DR
SHELBYVILLE KY
40065-8138
US

V. Phone/Fax

Practice location:
  • Phone: 503-633-1007
  • Fax:
Mailing address:
  • Phone: 502-633-1007
  • Fax: 502-437-0624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: ANGELA R SAGESER
Title or Position: PRESIDENT
Credential: ST
Phone: 502-633-1007