Individual
ADAM J SOUTHALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.T.
Contact information
Practice address
2700 STANLEY GAULT PKWY, STE 129, LOUISVILLE, KY 40223-5176
(859) 263-0595
(859) 263-0385
Mailing address
267 ZANDALE DR, LEXINGTON, KY 40503-2644
(270) 576-5770
(502) 489-5751
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
PT002931
WV
225100000X
Physical Therapist
Primary
PT005686
KY
225100000X
Physical Therapist
PT013083
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3083676
—
OH
05
—
3810019746
—
WV
Enumeration date
09/30/2010
Last updated
05/05/2016
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