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General NPI Number Information
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NPI Number | 1235588724
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Entity Type | Organization
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Legal Business Name | TERESA LONG PHYSICAL THERAPT INC
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Dates
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Enumeration Date | 06/06/2016
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Last Update Date | 06/06/2016
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Provider Practice Location Address
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Address Line | 1119 LAKE BLUFF CIR
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City | LOUISVILLE
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State | KY
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Zip | 40245-5239
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Country | US
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Telephone | 502-552-3530
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Fax | 502-244-5844
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Provider Business Mailing Address
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Address Line | 1119 LAKE BLUFF CIR
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City | LOUISVILLE
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State | KY
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Zip | 40245-5239
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Country | US
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Telephone | 502-552-3530
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Fax | 502-244-5844
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Authorized Official
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Title or Position | PT
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Name | MRS. TERESA LONG
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Credential | PT
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Telephone | 502-552-3530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 002535
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License Number State | KY
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