MEDICARE: VICKY HUMPHREY PT

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

General Provider Information

NPI Number	:	1750502696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKY HUMPHREY PT

Provider Business Mailing Address
First Line	:	5676 TARA HILL DR
Second Line	:
City	:	DUBLIN
State	:	OH
Zip	:	43017
Country	:	US
Telephone Number	:	614-889-2939
Fax Number	:

Provider Business Practice Location Address
First Line	:	5672 W BROAD ST
Second Line	:
City	:	GALLOWAY
State	:	OH
Zip	:	43119-8127
Country	:	US
Telephone Number	:	614-878-9000
Fax Number	:	614-878-8881

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

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	01/07/2011

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