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General NPI Number Information
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NPI Number | 1508374315
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Entity Type | Organization
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Legal Business Name | LOUISVILLE PHYSICAL MEDICINE PLLC
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Dates
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Enumeration Date | 01/15/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 3999 DUTCHMANS LN STE 4C
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City | LOUISVILLE
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State | KY
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Zip | 40207-4745
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Country | US
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Telephone | 502-744-3239
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 622
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City | GARDENDALE
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State | AL
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Zip | 35071-0622
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Country | US
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Telephone | 205-694-2020
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Fax | 205-380-0354
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Authorized Official
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Title or Position | QUALITY ASSURANCE DIRECTOR
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Name | JANE E WEIR
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Credential |
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Telephone | 205-694-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 26921
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License Number State | KY
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