Basic Information
Provider Information
NPI: 1881934172
EntityType: 2
ReplacementNPI:  
OrganizationName: SPRINGFIELD PHYSICAL THERAPY, LLC
LastName:  
FirstName:  
MiddleName:  
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Credential:  
OtherOrganizationName:  
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Mailing Information
Address1: 1113B LINCOLN PARK RD
Address2:  
City: SPRINGFIELD
State: KY
PostalCode: 400699573
CountryCode: US
TelephoneNumber: 8594819008
FaxNumber: 8594819004
Practice Location
Address1: 1113B LINCOLN PARK RD
Address2:  
City: SPRINGFIELD
State: KY
PostalCode: 400699573
CountryCode: US
TelephoneNumber: 8594819008
FaxNumber: 8594819004
Other Information
ProviderEnumerationDate: 02/22/2013
LastUpdateDate: 12/10/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
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ProviderGenderCode:  
AuthorizedOfficialLastName: CONNOR-ISRAEL
AuthorizedOfficialFirstName: KAY
AuthorizedOfficialMiddleName: A
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 8594819008
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MS.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: PT
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X002850KYY193400000X SINGLE SPECIALTY GROUPRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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