MEDICARE: ORTHO SPORT AND SPINE PHYSICIANS LOUISVILLE

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	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1881209310
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHO SPORT AND SPINE PHYSICIANS LOUISVILLE

Provider Business Mailing Address
First Line	:	5788 ROSWELL RD STE 100
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-4904
Country	:	US
Telephone Number	:	678-752-7246
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 BARRET AVE STE 104
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40204-1732
Country	:	US
Telephone Number	:	678-752-7246
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	FAITH A BELTZHOOVER
Credential	:
Telephone Number	:	678-752-7246

Provider Enumeration Date	:	09/11/2020
Last Update Date	:	02/22/2021

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