Provider Demographics
NPI:1730235516
Name:RAIBLE-WILSON, ERIN L (PT, OCS)
Entity type:Individual
Prefix:MS
First Name:ERIN
Middle Name:L
Last Name:RAIBLE-WILSON
Suffix:
Gender:F
Credentials:PT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4042 DUTCHMANS LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4712
Mailing Address - Country:US
Mailing Address - Phone:502-899-9363
Mailing Address - Fax:502-899-9365
Practice Address - Street 1:4042 DUTCHMANS LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4712
Practice Address - Country:US
Practice Address - Phone:502-899-9363
Practice Address - Fax:502-899-9365
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0039152251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6813OtherOCS CERTIFICATION
KY003915OtherKY STATE LICENSE
KY000000484215OtherANTHEM PROVIDER ID
KY0942504Medicare PIN