Organization
FM365 THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIA E WALL MS, OTR/L (OWNER)
(513) 305-0599
Entity
Organization
Contact information
Practice address
400 HILLCREST AVE, LOUISVILLE, KY 40206-1509
(513) 305-0599
Mailing address
400 HILLCREST AVE, LOUISVILLE, KY 40206-1509
(513) 305-0599
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100553370
—
KY
Enumeration date
10/09/2020
Last updated
10/09/2020
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