Healthcare Provider Details

I. General information

NPI: 1922055524
Provider Name (Legal Business Name): MIRIAM DARCY BELKNAP P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 04/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 HUSTON DR
SHEPHERDSVILLE KY
40165-7250
US

IV. Provider business mailing address

10500 GENTLEWIND CT
LOUISVILLE KY
40291-4473
US

V. Phone/Fax

Practice location:
  • Phone: 502-921-0272
  • Fax:
Mailing address:
  • Phone: 270-734-1449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT001309
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: