MEDICARE: THE P.T. PLACE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306901020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE P.T. PLACE, INC

Provider Business Mailing Address
First Line	:	358 S MAIN ST
Second Line	:
City	:	LEITCHFIELD
State	:	KY
Zip	:	42754-1428
Country	:	US
Telephone Number	:	270-259-0551
Fax Number	:	270-230-0009

Provider Business Practice Location Address
First Line	:	358 S MAIN ST
Second Line	:
City	:	LEITCHFIELD
State	:	KY
Zip	:	42754-1428
Country	:	US
Telephone Number	:	270-259-0551
Fax Number	:	270-230-0009

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	MR. DOUGLAS ALAN MANTOOTH
Credential	:
Telephone Number	:	270-259-0551

Provider Enumeration Date	:	12/22/2006
Last Update Date	:	08/22/2020

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Directions to “THE P.T. PLACE, INC ” Practice Location

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