Healthcare Provider Details

I. General information

NPI: 1982686887
Provider Name (Legal Business Name): MONTICELLO PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE SOUTHCREEK DR SUITE 116
MONTICELLO KY
42633-9472
US

IV. Provider business mailing address

1 S CREEK DR SUITE 116
MONTICELLO KY
42633-9472
US

V. Phone/Fax

Practice location:
  • Phone: 606-348-3314
  • Fax: 606-348-3315
Mailing address:
  • Phone: 606-348-3314
  • Fax: 606-348-3315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateKY

VIII. Authorized Official

Name: MR. SAMUEL M BROWN
Title or Position: OWNER
Credential: PT
Phone: 606-348-3314