Organization
BRTQL8 INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN C THOMAS SLP (PRESIDENT)
(859) 588-3709
Entity
Organization
Contact information
Practice address
105 WINDSOR PATH, SUITE 3, GEORGETOWN, KY 40324-9617
(859) 588-3709
(502) 603-0622
Mailing address
105 WINDSOR PATH, SUITE 3, GEORGETOWN, KY 40324-9617
(859) 588-3709
(502) 603-0622
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000745303
ANTHEM
KY
01
—
50071614
PASSPORT
KY
05
—
7100270990
—
KY
01
—
7100279260
EPSDT SPECIAL SERVICES
KY
Enumeration date
12/14/2011
Last updated
05/24/2016
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