Provider Demographics
NPI:1972188431
Name:PAST, KATHY ANN
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:ANN
Last Name:PAST
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 1:3807 SUMERLIN DR
Mailing Address - Street 2:
Mailing Address - City:BUCKNER
Mailing Address - State:KY
Mailing Address - Zip Code:40010-8826
Mailing Address - Country:US
Mailing Address - Phone:502-640-0283
Mailing Address - Fax:
Practice Address - Street 1:4801 OLYMPIA PARK PLZ STE 1600
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2095
Practice Address - Country:US
Practice Address - Phone:502-426-3353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY002533225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist