Healthcare Provider Details

I. General information

NPI: 1437108818
Provider Name (Legal Business Name): PHOENIX PHYSICAL THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 DANIEL DR
DANVILLE KY
40422-2527
US

IV. Provider business mailing address

122 DANIEL DR
DANVILLE KY
40422-2527
US

V. Phone/Fax

Practice location:
  • Phone: 859-236-4686
  • Fax: 859-236-4624
Mailing address:
  • Phone: 859-236-4686
  • Fax: 859-236-4624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5377
License Number StateKY

VIII. Authorized Official

Name: MR. MATTHEW JOHN SCHELLING
Title or Position: COMEMBER
Credential: MSPT
Phone: 859-236-4686