Healthcare Provider Details

I. General information

NPI: 1821144965
Provider Name (Legal Business Name): ANDREA JOY HUTSON MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S. LIBERTY STREET
BARBOURVILLE KY
40906-1437
US

IV. Provider business mailing address

383 CORBIN CENTER DRIVE
CORBIN KY
40701-1895
US

V. Phone/Fax

Practice location:
  • Phone: 606-546-4112
  • Fax: 606-546-8456
Mailing address:
  • Phone: 606-526-2909
  • Fax: 606-526-2901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11443
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number004429
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: