Individual
TAMARA D HUSTED
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T.
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
(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
—
000000295678
ANTHEM PRACTITIONER PIN
KY
01
—
7703422
AETNA PIN
KY
Enumeration date
10/03/2006
Last updated
07/08/2007
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