Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 006329 | KY |
N | 2251X0800X | Physical Therapist - Orthopedic | T13035 | KY |
NPI | 1013345180 |
---|---|
Provider Name | Lori Weickel |
First Address | Louisville, KY 40291-4522 |
Second Address | Louisville, KY 40291-4522 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2013 |
Last Update Date | 13/09/2021 |