Healthcare Provider Details

I. General information

NPI: 1770636987
Provider Name (Legal Business Name): JEFFREY R. CAUDILL PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 WALLER AVE STE 275
LEXINGTON KY
40504-2930
US

IV. Provider business mailing address

330 WALLER AVE STE 275
LEXINGTON KY
40504-2930
US

V. Phone/Fax

Practice location:
  • Phone: 598-447-8600
  • Fax: 598-447-8599
Mailing address:
  • Phone: 598-447-8600
  • Fax: 598-447-8599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number003750
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: