MEDICARE: ASSOCAITES IN PEDIATRIC THERAPY LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225100000X	Physical Therapist
2	225X00000X	Occupational Therapist
3	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1114407418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSOCAITES IN PEDIATRIC THERAPY LLC

Provider Business Mailing Address
First Line	:	90 HOWARD DR
Second Line	:
City	:	SHELBYVILLE
State	:	KY
Zip	:	40065-8138
Country	:	US
Telephone Number	:	502-633-1007
Fax Number	:	502-437-0624

Provider Business Practice Location Address
First Line	:	709 W STOCKTON ST
Second Line	:
City	:	EDMONTON
State	:	KY
Zip	:	42129-9432
Country	:	US
Telephone Number	:	502-633-1007
Fax Number	:	502-437-0624

Authorized Official
Title or Position	:	OWNER
Name	:	ANGELA SAGESER
Credential	:
Telephone Number	:	502-633-1007

Provider Enumeration Date	:	08/16/2018
Last Update Date	:	08/16/2018

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Directions to “ASSOCAITES IN PEDIATRIC THERAPY LLC ” Practice Location

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