=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275684573
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRIS ALAN FORBES P.T.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2007
-----------------------------------------------------
Last Update Date | 09/12/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1100 GLENSBORO RD STE 1
-----------------------------------------------------
City | LAWRENCEBURG
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40342-9084
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-839-9755
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 695
-----------------------------------------------------
City | FRANKFORT
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40602-0695
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-226-3858
-----------------------------------------------------
Fax | 502-223-9829
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 004080
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------