Healthcare Provider Details

I. General information

NPI: 1063512697
Provider Name (Legal Business Name): GREEN HILL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 LONG RUN RD
LOUISVILLE KY
40245-4334
US

IV. Provider business mailing address

1410 LONG RUN ROAD
LOUISVILLE KY
40245
US

V. Phone/Fax

Practice location:
  • Phone: 502-265-8847
  • Fax: 502-244-6631
Mailing address:
  • Phone: 502-244-8011
  • Fax: 502-244-6631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberR4085
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateKY

VIII. Authorized Official

Name: ANDREA BURTON
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 502-265-8847