Provider Demographics
NPI:1871620104
Name:PHYSICAL THERAPY GROUP, INC
Entity type:Organization
Organization Name:PHYSICAL THERAPY GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-493-3800
Mailing Address - Street 1:4233 BARDSTOWN RD
Mailing Address - Street 2:100C
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-3280
Mailing Address - Country:US
Mailing Address - Phone:502-493-3800
Mailing Address - Fax:502-493-3830
Practice Address - Street 1:4233 BARDSTOWN RD
Practice Address - Street 2:100C
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-3280
Practice Address - Country:US
Practice Address - Phone:502-493-3800
Practice Address - Fax:502-493-3830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000179063OtherANTHEM HEALTH PLAN
KY6523Medicare ID - Type Unspecified