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General NPI Number Information
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NPI Number | 1386306454
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Entity Type | Organization
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Legal Business Name | THERAPY HERO
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Dates
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Enumeration Date | 10/06/2021
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Last Update Date | 10/06/2021
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Provider Practice Location Address
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Address Line | 2500 W BROADWAY
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City | LOUISVILLE
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State | KY
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Zip | 40211-1081
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Country | US
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Telephone | 502-930-9638
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Fax | 833-378-1752
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Provider Business Mailing Address
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Address Line | 2500 W BROADWAY
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City | LOUISVILLE
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State | KY
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Zip | 40211-1081
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | MR. RAYSHAD WITHROW
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Credential |
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Telephone | 682-249-9820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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