Healthcare Provider Details

I. General information

NPI: 1487107785
Provider Name (Legal Business Name): APPALACHIAN PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2016
Last Update Date: 08/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21937 MAIN ST
HYDEN KY
41749-8567
US

IV. Provider business mailing address

PO BOX 2121
HYDEN KY
41749-2121
US

V. Phone/Fax

Practice location:
  • Phone: 606-672-6683
  • Fax: 606-672-6682
Mailing address:
  • Phone: 606-672-6683
  • Fax: 606-672-6682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number005735
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number005735
License Number StateKY

VIII. Authorized Official

Name: HEATHER N BOWLING
Title or Position: PHYSICAL THERAPIST
Credential: PT
Phone: 606-672-6683