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General NPI Number Information
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NPI Number | 1831583574
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Entity Type | Individual
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Provider Name | GEORGE CLOUD III PTA
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Gender | Male
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Dates
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Enumeration Date | 03/19/2015
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Last Update Date | 03/19/2015
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Provider Practice Location Address
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Address Line | 2701 CHESTNUT STATION CT
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City | LOUISVILLE
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State | KY
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Zip | 40299-6395
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Country | US
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Telephone | 800-335-1060
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Fax |
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Provider Business Mailing Address
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Address Line | 3040 99TH ST
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City | HIGHLAND
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State | IN
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Zip | 46322-3345
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Country | US
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Telephone | 708-420-6387
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 160.005886
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 06004967A
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License Number State | IN
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