MEDICARE: EMMA BLUE PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	CP030455A	KY
2	225200000X	Physical Therapy Assistant	06006772A	IN

General Provider Information

NPI Number	:	1093657868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMA BLUE PTA

Provider Business Mailing Address
First Line	:	1312 E 8TH ST
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-3346
Country	:	US
Telephone Number	:	859-421-9199
Fax Number	:

Provider Business Practice Location Address
First Line	:	1312 E 8TH ST
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-3346
Country	:	US
Telephone Number	:	859-421-9199
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2026
Last Update Date	:	04/08/2026

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