Healthcare Provider Details

I. General information

NPI: 1679201990
Provider Name (Legal Business Name): LEANN CULBERTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2022
Last Update Date: 08/14/2022
Certification Date: 08/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 EASTPOINT PKWY STE 102
LOUISVILLE KY
40223-4154
US

IV. Provider business mailing address

2400 EASTPOINT PKWY STE 102
LOUISVILLE KY
40223-4154
US

V. Phone/Fax

Practice location:
  • Phone: 502-253-6689
  • Fax: 502-253-6680
Mailing address:
  • Phone: 502-253-6689
  • Fax: 502-253-6680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number001308
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: