Individual provider Active NPI

Brendan Doksa, PT

  • Physical Therapist
  • Louisville, KY
National Provider Identifier
1710673801
Registry record updated Apr 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
007370 Issued in KY
Practice address
1328 Hepburn Ave
Louisville, KY 40204-1614
Phone
(440) 665-4278
NPI assigned
Apr 12, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 007370 KY Primary

Addresses

Primary practice location

1328 Hepburn Ave
Louisville, KY 40204-1614

Mailing address

1328 Hepburn Ave
Louisville, KY 40204-1614
Phone (440) 665-4278

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230517003075 KY Practitioner - Physical Therapist in Private Practice 5193181113 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
007370KYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
SN Kentuckiana Rehab, LLC Physical Therapist Current Accepting new patients
Kentucky Orthopedic Rehabilitation, LLC Physical Therapist Current Accepting new patients
Kentucky Orthopedic Rehabilitation, LLC CurrentSince May 2, 2023 Accepting new patients
Kentucky Orthopedic Rehabilitation LLC CurrentSince May 2, 2023 Accepting new patients
SN Kentuckiana Rehab, LLC CurrentSince May 2, 2023 Accepting new patients
SN Kentuckiana Rehab, LLC CurrentSince May 2, 2023 Accepting new patients
SN Kentuckiana Rehab, LLC Past Accepting new patients

Locations

930 Jamestown St
Columbia, KY 42728
Phone (270) 751-8730

12613 Taylorsville Rd
Ste 118
Louisville, KY 40299
Phone (502) 267-1480

210 E Gray St
Ste 807
Louisville, KY 40202
Phone (502) 587-9350

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1681257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681257600000",
    "number": "1710673801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1328 HEPBURN AVE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402041614",
            "telephone_number": "440-665-4278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1328 HEPBURN AVE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402041614",
            "telephone_number": "440-665-4278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOKSA",
        "first_name": "BRENDAN",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-04-12",
        "last_updated": "2023-04-12",
        "certification_date": "2023-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KY",
            "license": "007370",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.