Healthcare Provider Details

I. General information

NPI: 1578863254
Provider Name (Legal Business Name): ADVANCED BIOMECHANICAL CONCEPTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2010
Last Update Date: 03/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11872 CAPITAL WAY
LOUISVILLE KY
40299-6332
US

IV. Provider business mailing address

11872 CAPITAL WAY
LOUISVILLE KY
40299-6332
US

V. Phone/Fax

Practice location:
  • Phone: 502-261-1488
  • Fax: 502-261-1470
Mailing address:
  • Phone: 502-261-1488
  • Fax: 502-261-1470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberCO004117
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: BECKY FOSTER
Title or Position: MANAGER
Credential:
Phone: 502-261-1488