1619104296 NPI number — KENTUCKY HAND & PHYSICAL THERAPY, PLLC

Table of content: (NPI 1619104296)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619104296 NPI number — KENTUCKY HAND & PHYSICAL THERAPY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENTUCKY HAND & PHYSICAL THERAPY, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619104296
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
151 N EAGLE CREEK DR
Provider Second Line Business Mailing Address:
STE 400
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40509-1889
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-264-8866
Provider Business Mailing Address Fax Number:
859-264-1167

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 WINDSOR PATH
Provider Second Line Business Practice Location Address:
STE 2
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-863-1674
Provider Business Practice Location Address Fax Number:
502-863-1676
Provider Enumeration Date:
06/22/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MCGOVERN
Authorized Official First Name:
BRIDGET
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
859-264-8866

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 07184 . This is a "MEDICARE/GROUP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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