Healthcare Provider Details

I. General information

NPI: 1144875972
Provider Name (Legal Business Name): REBECCA A PRATT MS, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 08/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5120 DIXIE HWY STE 103
LOUISVILLE KY
40216-1775
US

IV. Provider business mailing address

5120 DIXIE HWY STE 103
LOUISVILLE KY
40216-1775
US

V. Phone/Fax

Practice location:
  • Phone: 502-449-0449
  • Fax: 502-708-3054
Mailing address:
  • Phone: 502-449-0449
  • Fax: 502-708-3054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT1534
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: