Healthcare Provider Details

I. General information

NPI: 1801873716
Provider Name (Legal Business Name): SOUTHEASTERN KENTUCKY PHYSICAL THERAPY CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 12/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 18TH ST
CORBIN KY
40701-2721
US

IV. Provider business mailing address

1480 18TH ST
CORBIN KY
40701-2721
US

V. Phone/Fax

Practice location:
  • Phone: 606-528-0870
  • Fax: 606-528-3449
Mailing address:
  • Phone: 606-528-0870
  • Fax: 606-528-3449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. WALTER KIM CHEARY
Title or Position: OWNER
Credential: PT
Phone: 606-528-0870