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General NPI Number Information
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NPI Number | 1619642535
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Entity Type | Organization
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Legal Business Name | BARDSTOWN THERAPY & CHIRO, INC.
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Dates
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Enumeration Date | 08/12/2021
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Last Update Date | 08/12/2021
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Provider Practice Location Address
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Address Line | 4229 BARDSTOWN RD STE 318
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City | LOUISVILLE
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State | KY
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Zip | 40218-3281
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Country | US
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Telephone | 502-963-1955
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Fax |
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Provider Business Mailing Address
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Address Line | 4229 BARDSTOWN RD STE 318
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City | LOUISVILLE
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State | KY
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Zip | 40218-3281
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Country | US
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Telephone | 502-963-1955
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GIANNYS MATO
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Credential | LMT
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Telephone | 502-963-1955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number |
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License Number State |
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