=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578096616
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INSPIRE THERAPY SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2017
-----------------------------------------------------
Last Update Date | 04/05/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 452 BLUEBIRD DR
-----------------------------------------------------
City | RUSSELL
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41169-1570
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-922-2596
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 452 BLUEBIRD DR
-----------------------------------------------------
City | RUSSELL
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41169-1570
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-922-2596
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AGENCY ADMINISTRATOR/OWNER
-----------------------------------------------------
Name | ANITA LYNN FRAZIER-BROOKS
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 606-922-2596
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------