Healthcare Provider Details

I. General information

NPI: 1023174539
Provider Name (Legal Business Name): MOUNTAIN PHYSICAL THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 COURT STREET
BOONEVILLE KY
41314
US

IV. Provider business mailing address

PO BOX 1404
BOONEVILLE KY
41314-1404
US

V. Phone/Fax

Practice location:
  • Phone: 606-593-6003
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number003956
License Number StateKY

VIII. Authorized Official

Name: MORGAN S HOOKER
Title or Position: OWNER
Credential: DPT
Phone: 606-596-0701