Healthcare Provider Details

I. General information

NPI: 1588749592
Provider Name (Legal Business Name): INEZ PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 10/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 OTTO DR
INEZ KY
41224-8807
US

IV. Provider business mailing address

65 OTTO DR
INEZ KY
41224-8807
US

V. Phone/Fax

Practice location:
  • Phone: 606-298-4567
  • Fax: 606-298-7073
Mailing address:
  • Phone: 606-298-4567
  • Fax: 606-298-7073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number002946
License Number StateKY

VIII. Authorized Official

Name: MRS. TRISHA M GIOMPALO
Title or Position: OWNER PRESIDENT
Credential: PT
Phone: 606-298-4567