Healthcare Provider Details

I. General information

NPI: 1326574112
Provider Name (Legal Business Name): PERRY JONATHAN ARNETT PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1939 ALMA CT
MADISONVILLE KY
42431-9505
US

IV. Provider business mailing address

122 W UNION ST
HARTFORD KY
42347-1416
US

V. Phone/Fax

Practice location:
  • Phone: 270-836-3373
  • Fax:
Mailing address:
  • Phone: 270-298-3112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA00741
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: