Healthcare Provider Details

I. General information

NPI: 1881648913
Provider Name (Legal Business Name): PHILLIP B HERRELL PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 06/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 E BROADWAY ST STE B
EMINENCE KY
40019-1149
US

IV. Provider business mailing address

3810 ZARING MILL CIR
LOUISVILLE KY
40241-3052
US

V. Phone/Fax

Practice location:
  • Phone: 502-845-0005
  • Fax: 502-845-0006
Mailing address:
  • Phone: 502-767-5228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT003040
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: