Provider Demographics
NPI:1588306401
Name:GEISEN, PAMELA KAYE
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:KAYE
Last Name:GEISEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8119 BOHANNON STATION RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-4028
Mailing Address - Country:US
Mailing Address - Phone:502-693-2193
Mailing Address - Fax:
Practice Address - Street 1:108 DIAGNOSTIC DR # 512UITEC
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-6556
Practice Address - Country:US
Practice Address - Phone:512-639-4795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT-001289225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist