Organization
LAUNCH THERAPY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COURTNEY PATRICK OTD, OTR/L (OWNER)
(270) 893-5600
Entity
Organization
Contact information
Practice address
314 HIGHLAND LICK RD, RUSSELLVILLE, KY 42276-9275
(270) 893-5600
Mailing address
610 GREEN VALLEY DR, RUSSELLVILLE, KY 42276-8808
(270) 893-5600
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100872860
—
KY
Enumeration date
05/05/2022
Last updated
05/03/2023
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