Healthcare Provider Details

I. General information

NPI: 1942409644
Provider Name (Legal Business Name): RENEE M WURTH PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 JACKSON ST
PADUCAH KY
42003-7602
US

IV. Provider business mailing address

2855 JACKSON ST
PADUCAH KY
42003-7602
US

V. Phone/Fax

Practice location:
  • Phone: 270-415-3618
  • Fax: 270-415-3601
Mailing address:
  • Phone: 270-415-3618
  • Fax: 270-415-3601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberKY-004303
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: