Healthcare Provider Details

I. General information

NPI: 1104002559
Provider Name (Legal Business Name): RHONDA EVANS CALDWELL P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 WALLER AVE SUITE 300 UK NICU GRAD CLINIC
LEXINGTON KY
40504-2915
US

IV. Provider business mailing address

333 WALLER AVE SUITE 300 UK NICU GRAD CLINIC
LEXINGTON KY
40504-2915
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6469
  • Fax: 859-225-7155
Mailing address:
  • Phone: 859-323-6469
  • Fax: 859-225-7155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number001843
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: