MEDICARE: THE MIDDLE WAY, LLC

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1841975612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE MIDDLE WAY, LLC

Provider Business Mailing Address
First Line	:	1417 E BRECKINRIDGE ST
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40204-1707
Country	:	US
Telephone Number	:	847-899-4338
Fax Number	:

Provider Business Practice Location Address
First Line	:	1930 BISHOP LN STE 101
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-1962
Country	:	US
Telephone Number	:	847-899-4338
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KIMBERLY C CONINX
Credential	:	PT, DPT
Telephone Number	:	847-899-4338

Provider Enumeration Date	:	06/20/2023
Last Update Date	:	06/20/2023

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Directions to “THE MIDDLE WAY, LLC ” Practice Location

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