Healthcare Provider Details

I. General information

NPI: 1538537758
Provider Name (Legal Business Name): JEROME EARL HOARD PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2015
Last Update Date: 09/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4747 ALBEN BARKLEY DR
PADUCAH KY
42001-6789
US

IV. Provider business mailing address

2510 IL 145 RD
METROPOLIS IL
62960-4929
US

V. Phone/Fax

Practice location:
  • Phone: 270-444-9661
  • Fax:
Mailing address:
  • Phone: 618-524-4538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-002068
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: