Healthcare Provider Details

I. General information

NPI: 1700215076
Provider Name (Legal Business Name): SABRINA PLETZ PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 SYCAMORE AVE
LOUISVILLE KY
40206-2013
US

IV. Provider business mailing address

2141 SYCAMORE AVE
LOUISVILLE KY
40206-2013
US

V. Phone/Fax

Practice location:
  • Phone: 502-384-9052
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA03116
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT943
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: