Healthcare Provider Details

I. General information

NPI: 1740144633
Provider Name (Legal Business Name): ALLIZA HOUSH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4402 CHURCHMAN AVE STE 106
LOUISVILLE KY
40215-1192
US

IV. Provider business mailing address

4402 CHURCHMAN AVE STE 106
LOUISVILLE KY
40215-1192
US

V. Phone/Fax

Practice location:
  • Phone: 502-363-7800
  • Fax: 502-363-7848
Mailing address:
  • Phone: 502-363-7800
  • Fax: 502-363-7848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number289400
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: