Organization
BLUE GRASS PHYSIOTHERAPY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE WILLIAM LOZE PHYSICAL THERAPIST (CO-OWNER)
(606) 678-5708
Entity
Organization
Contact information
Practice address
117 TRADEPARK DR, SOMERSET, KY 42503-3428
(606) 678-5708
(606) 678-4336
Mailing address
117 TRADEPARK DR, SOMERSET, KY 42503-3428
(606) 678-5708
(606) 678-4336
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
64-00220
UHC PROVIDER NUMBERS
KY
Enumeration date
10/05/2006
Last updated
08/22/2020
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