Healthcare Provider Details

I. General information

NPI: 1457755357
Provider Name (Legal Business Name): DANIEL JOE CAUDILL PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2014
Last Update Date: 10/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N HURSTBOURNE PKWY STE 200
LOUISVILLE KY
40222-5158
US

IV. Provider business mailing address

413 CRASES BR
LETCHER KY
41832-9053
US

V. Phone/Fax

Practice location:
  • Phone: 502-412-5847
  • Fax:
Mailing address:
  • Phone: 606-262-4969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA03262
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: