Basic Information
Provider Information
NPI: 1306437215
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OSBORNE-GILL
FirstName: RAMONA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 110 DESTIN CIRCLE
Address2:  
City: ELIZABETHTOWN
State: KY
PostalCode: 42701
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1111 RING RD
Address2:  
City: ELIZABETHTOWN
State: KY
PostalCode: 427014900
CountryCode: US
TelephoneNumber: 2707065010
FaxNumber: 2707065105
Other Information
ProviderEnumerationDate: 02/02/2021
LastUpdateDate: 02/02/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/18/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X004982KYY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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