Organization
LOUISVILLE PHYSICAL MEDICINE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANE E WEIR (QUALITY ASSURANCE DIRECTOR)
(205) 694-2020
Entity
Organization
Contact information
Practice address
3999 DUTCHMANS LN STE 4C, LOUISVILLE, KY 40207-4745
(502) 744-3239
Mailing address
PO BOX 622, GARDENDALE, AL 35071-0622
(205) 694-2020
(205) 380-0354
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
26921
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000509322
ANTHEM
KY
01
—
50013453
PASSPORT
KY
05
—
64269210
—
KY
Enumeration date
01/15/2018
Last updated
06/16/2018
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