Healthcare Provider Details

I. General information

NPI: 1417662941
Provider Name (Legal Business Name): CARMEN TERRELL PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2023
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TRILLIUM WAY
CORBIN KY
40701-8426
US

IV. Provider business mailing address

1453 LITTLE SPRUCE CREEK RD
CORBIN KY
40701-8328
US

V. Phone/Fax

Practice location:
  • Phone: 606-528-1212
  • Fax:
Mailing address:
  • Phone: 606-627-7161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number006539
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: