Organization
AT HOME PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMARA D HUSTED P.T. (OWNER)
(502) 420-0901
Entity
Organization
Contact information
Practice address
512 VINELEAF DR, LOUISVILLE, KY 40222-4691
(502) 420-0901
(502) 420-0901
Mailing address
512 VINELEAF DR, LOUISVILLE, KY 40222-4691
(502) 420-0901
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
000923
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000295673
ANTHEM GROUP PIN NUMBER
KY
Enumeration date
10/03/2006
Last updated
09/20/2007
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