Healthcare Provider Details

I. General information

NPI: 1174912117
Provider Name (Legal Business Name): PAUL SYMPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2015
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2116 BUECHEL BANK RD
LOUISVILLE KY
40218-3521
US

IV. Provider business mailing address

2116 BUECHEL BANK RD
LOUISVILLE KY
40218-3521
US

V. Phone/Fax

Practice location:
  • Phone: 502-499-9383
  • Fax: 502-499-3528
Mailing address:
  • Phone: 502-499-9383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA02533
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06004945A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: