Healthcare Provider Details

I. General information

NPI: 1487652848
Provider Name (Legal Business Name): LYNN KIBBONS COLLINS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 03/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 MERIDIAN WAY STE 9
RICHMOND KY
40475-2876
US

IV. Provider business mailing address

5027 ATWOOD DR STE 2B
RICHMOND KY
40475-8322
US

V. Phone/Fax

Practice location:
  • Phone: 859-626-3131
  • Fax: 859-625-1109
Mailing address:
  • Phone: 859-625-0001
  • Fax: 859-625-1109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number01189
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: