| |
11872 Capital Way, Louisville, KY 40299-6332 | |
(502) 261-1488 | |
(502) 261-1470 |
Full Name | |
---|---|
Type | Facility |
Speciality | Prosthetic/orthotic Supplier |
Location | 11872 Capital Way, Louisville, Kentucky |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1578863254 | NPI | - | NPPES |
90008012 | Medicaid | KY | |
1689798522 | Other | KY | ANTHEM |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
225100000X | Physical Therapist | (* (Not Available)) | Secondary |
335E00000X | Prosthetic/orthotic Supplier | CO004117 (Kentucky) | Primary |
Mailing Address | Practice Location Address |
---|---|
11872 Capital Way, Louisville, KY 40299-6332 Ph: (502) 261-1488 | 11872 Capital Way, Louisville, KY 40299-6332 Ph: (502) 261-1488 |