Healthcare Provider Details

I. General information

NPI: 1700080819
Provider Name (Legal Business Name): KEARNS PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 CREEKROCK CIR
NICHOLASVILLE KY
40356-8037
US

IV. Provider business mailing address

107 CREEKROCK CIR
NICHOLASVILLE KY
40356-8037
US

V. Phone/Fax

Practice location:
  • Phone: 859-401-2941
  • Fax:
Mailing address:
  • Phone: 859-401-2941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number004930
License Number StateKY

VIII. Authorized Official

Name: MRS. ELISE K WATSON
Title or Position: MANAGER
Credential: PT
Phone: 859-401-2941