Healthcare Provider Details

I. General information

NPI: 1376450882
Provider Name (Legal Business Name): JANIS HOLDEN PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SHELBY STATION DR
LOUISVILLE KY
40245-4186
US

IV. Provider business mailing address

300 SHELBY STATION DR
LOUISVILLE KY
40245-4186
US

V. Phone/Fax

Practice location:
  • Phone: 502-753-6200
  • Fax: 502-365-4056
Mailing address:
  • Phone: 502-753-6200
  • Fax: 502-365-4056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA01028
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: