MEDICARE: PHYSICAL THERAPY PROS LLC

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	004285	KY

General Provider Information

NPI Number	:	1609210194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICAL THERAPY PROS LLC

Provider Business Mailing Address
First Line	:	PO BOX 1559
Second Line	:
City	:	ELIZABETHTOWN
State	:	KY
Zip	:	42702-1559
Country	:	US
Telephone Number	:	270-900-4052
Fax Number	:	270-900-4054

Provider Business Practice Location Address
First Line	:	2624 RING RD
Second Line	:	SUITE 101
City	:	ELIZABETHTOWN
State	:	KY
Zip	:	42701-9118
Country	:	US
Telephone Number	:	270-900-4052
Fax Number	:	270-900-4054

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. HOLLY J LEWIS
Credential	:	PT, DPT, OCS
Telephone Number	:	270-900-4052

Provider Enumeration Date	:	04/26/2013
Last Update Date	:	01/07/2020

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Directions to “PHYSICAL THERAPY PROS LLC ” Practice Location

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