Organization
ORTHOPAEDIC MOTION & SPORT PHYSICAL
Active
Organization
ORTHOPAEDIC MOTION & SPORT PHYSICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BRIDGID M MAHAN DPT, OCS, SCS (OWNER)
(502) 899-4760
Entity
Organization
Contact information
Practice address
6008 BROWNSBORO PARK BLVD, SUITE C, LOUISVILLE, KY 40207-1295
(502) 899-4760
(502) 899-4719
Mailing address
6008 BROWNSBORO PARK BLVD, SUITE C, LOUISVILLE, KY 40207-1295
(502) 899-4760
(502) 899-4719
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
004050
KY
2251S0007X
Sports Physical Therapist
004050
KY
2251X0800X
Orthopedic Physical Therapist
004050
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000505120
ANTHEM
KY
Enumeration date
09/28/2006
Last updated
09/01/2015
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