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General NPI Number Information
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NPI Number | 1720535677
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Entity Type | Organization
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Legal Business Name | MB INVESTORS
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Dates
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Enumeration Date | 09/08/2016
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Last Update Date | 09/08/2016
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Provider Practice Location Address
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Address Line | 931 S 3RD ST
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City | LOUISVILLE
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State | KY
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Zip | 40203-2215
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Country | US
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Telephone | 502-409-4174
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Fax |
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Provider Business Mailing Address
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Address Line | 401 W MAIN ST SUITE 2014
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City | LOUISVILLE
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State | KY
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Zip | 40202-2948
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Country | US
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Telephone | 502-409-4174
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Fax |
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Authorized Official
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Title or Position | COO
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Name | BART MILLER
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Credential |
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Telephone | 502-235-1099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 101132
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License Number State | KY
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