Healthcare Provider Details

I. General information

NPI: 1679549083
Provider Name (Legal Business Name): PADUCAH PHYSICAL THERAPY AND PSCHOLOGY CENTER, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2831 LONE OAK RD
PADUCAH KY
42003-8041
US

IV. Provider business mailing address

2831 LONE OAK RD
PADUCAH KY
42003-8041
US

V. Phone/Fax

Practice location:
  • Phone: 270-554-8373
  • Fax: 270-554-8987
Mailing address:
  • Phone: 270-554-8373
  • Fax: 270-554-8987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number100605
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number100605
License Number StateKY

VIII. Authorized Official

Name: PATRICIA BURKS
Title or Position: CLINIC DIRECTOR
Credential: LPT
Phone: 270-554-8373