Healthcare Provider Details

I. General information

NPI: 1265705172
Provider Name (Legal Business Name): MARY AGNEESSENS THM,PHDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2012
Last Update Date: 02/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 WEST MAIN ST SUITE 301
LEXINGTON KY
40507-1646
US

IV. Provider business mailing address

3580 CUMMINS FERRY RD
VERSAILLES KY
40383-9614
US

V. Phone/Fax

Practice location:
  • Phone: 602-799-6279
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: