Healthcare Provider Details

I. General information

NPI: 1699067595
Provider Name (Legal Business Name): FOR THE KIDS PHYSICAL THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 05/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 LYNNWOOD WAY
LOUISVILLE KY
40299-3101
US

IV. Provider business mailing address

3009 LYNNWOOD WAY
LOUISVILLE KY
40299-3101
US

V. Phone/Fax

Practice location:
  • Phone: 502-292-8722
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number005375
License Number StateKY

VIII. Authorized Official

Name: LINDSAY MARGARET HAYCRAFT
Title or Position: OWNER
Credential: PT
Phone: 502-292-8722