Provider Demographics
NPI:1174912117
Name:SYMPSON, PAUL
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:SYMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 BUECHEL BANK RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-3521
Mailing Address - Country:US
Mailing Address - Phone:502-499-9383
Mailing Address - Fax:
Practice Address - Street 1:2116 BUECHEL BANK RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-3521
Practice Address - Country:US
Practice Address - Phone:502-499-9383
Practice Address - Fax:502-499-3528
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA02533225200000X
IN06004945A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant