Healthcare Provider Details

I. General information

NPI: 1568272524
Provider Name (Legal Business Name): EMERGE TX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2025
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 BISHOP LN STE 404
LOUISVILLE KY
40218-1922
US

IV. Provider business mailing address

1941 BISHOP LN STE 404
LOUISVILLE KY
40218-1922
US

V. Phone/Fax

Practice location:
  • Phone: 502-488-2753
  • Fax: 502-308-4725
Mailing address:
  • Phone: 502-488-2753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: TUDOR PANTA
Title or Position: FOUNDER & CEO
Credential: OTR
Phone: 502-488-2753