Healthcare Provider Details

I. General information

NPI: 1952672248
Provider Name (Legal Business Name): NATHAN JOE ADDINGTON PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2012
Last Update Date: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NURSING HOME LN
PIKEVILLE KY
41501-6896
US

IV. Provider business mailing address

1421 HIGHWAY 3406
MAYKING KY
41837-9014
US

V. Phone/Fax

Practice location:
  • Phone: 606-639-0163
  • Fax:
Mailing address:
  • Phone: 606-633-0491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA02337
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: