Provider Demographics
NPI:1154765550
Name:THERAPY ASSOCIATES OF LOUISVILLE, LLC
Entity type:Organization
Organization Name:THERAPY ASSOCIATES OF LOUISVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUVALL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:727-768-3877
Mailing Address - Street 1:542 JOHNS PASS AVE
Mailing Address - Street 2:
Mailing Address - City:MADEIRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33708-2366
Mailing Address - Country:US
Mailing Address - Phone:727-768-3877
Mailing Address - Fax:
Practice Address - Street 1:4810 POPLAR PLACE DR STE 100
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-2383
Practice Address - Country:US
Practice Address - Phone:727-768-3877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT9908174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty