Healthcare Provider Details

I. General information

NPI: 1902983430
Provider Name (Legal Business Name): PREMIER THERAPY & HEALTH CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 10/16/2022
Certification Date: 10/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 N CAROL MALONE BLVD STE A
GRAYSON KY
41143-1126
US

IV. Provider business mailing address

PO BOX 1240
ASHLAND KY
41105-1240
US

V. Phone/Fax

Practice location:
  • Phone: 606-474-0157
  • Fax: 606-474-0890
Mailing address:
  • Phone: 606-325-7955
  • Fax: 606-325-9848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. TODD MUNSON
Title or Position: PRESIDENT
Credential: PT OCS
Phone: 606-325-7955