MEDICARE: KRISTA M MCBRIDE PT

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	2251X0800X	Orthopedic Physical Therapist	PT-003943	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT-003943	OTHER	KY	STATE LICENSE

General Provider Information

NPI Number	:	1669626966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTA M MCBRIDE PT

Provider Business Mailing Address
First Line	:	6000 BROWNSBORO PARK BLVD
Second Line	:	SUITE E
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-7201
Country	:	US
Telephone Number	:	502-855-2489
Fax Number	:	502-895-7716

Provider Business Practice Location Address
First Line	:	6000 BROWNSBORO PARK BLVD
Second Line	:	SUITE E
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-7201
Country	:	US
Telephone Number	:	502-855-2489
Fax Number	:	502-895-7716

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

Provider Enumeration Date	:	11/13/2008
Last Update Date	:	06/13/2014

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Directions to “ KRISTA M MCBRIDE PT” Practice Location

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