Healthcare Provider Details

I. General information

NPI: 1073778445
Provider Name (Legal Business Name): CHARLES WORKMAN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 VERSAILLES RD
LEXINGTON KY
40504-1405
US

IV. Provider business mailing address

415 TALBOTT DR
WILMORE KY
40390-1039
US

V. Phone/Fax

Practice location:
  • Phone: 859-376-7125
  • Fax:
Mailing address:
  • Phone: 859-858-8430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number3918
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: