MEDICARE: DR. PAUL WILDER KLINE PT, DPT

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	225100000X	Physical Therapist	006267	KY

General Provider Information

NPI Number	:	1528491842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL WILDER KLINE PT, DPT

Provider Business Mailing Address
First Line	:	3800 NICHOLASVILLE RD
Second Line	:	APT 31632
City	:	LEXINGTON
State	:	KY
Zip	:	40503-6346
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1650 BRYAN STATION RD
Second Line	:	#110
City	:	LEXINGTON
State	:	KY
Zip	:	40505-2138
Country	:	US
Telephone Number	:	859-293-6133
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2013
Last Update Date	:	08/11/2013

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