MEDICARE: MAYSVILLE PHYSICAL THERAPY, 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	PT001912	KY

General Provider Information

NPI Number	:	1922303882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAYSVILLE PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	1925 OLD MAIN ST
Second Line	:	SUITE 1
City	:	MAYSVILLE
State	:	KY
Zip	:	41056-8984
Country	:	US
Telephone Number	:	606-759-4719
Fax Number	:

Provider Business Practice Location Address
First Line	:	1925 OLD MAIN ST
Second Line	:	SUITE 1
City	:	MAYSVILLE
State	:	KY
Zip	:	41056-8984
Country	:	US
Telephone Number	:	606-759-4719
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JULIE KEY MCKAY
Credential	:	P.T.
Telephone Number	:	606-759-4719

Provider Enumeration Date	:	01/24/2011
Last Update Date	:	11/17/2014

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