Organization
CEREBRAL PALSY KIDS CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRITTANY LUTKE (EXECUTIVE DIRECTOR)
(502) 635-6397
Entity
Organization
Contact information
Practice address
982 EASTERN PARKWAY, LOUISVILLE, KY 40217-1501
(502) 635-6397
(502) 635-1147
Mailing address
982 EASTERN PARKWAY, # 6, LOUISVILLE, KY 40217-1501
(502) 635-6397
(502) 635-1147
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
207XP3100X
Pediatric Orthopaedic Surgery Physician
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200067440A
MEDICAID
IN
01
—
22000000217777
ANTHEM BLUE SHIELD OT
—
01
—
22000000217778
ANTHEM BLUE SHIELD ST
—
01
—
22000000217779
ANTHEM BLUE SHIELD PT
—
01
—
50000598
PASSPORT THERAPY
KY
01
—
50006662
PASSPORT MD
KY
05
—
65901993
—
KY
01
—
90630567
DME MEDICAID
KY
Enumeration date
12/08/2006
Last updated
11/21/2024
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