Healthcare Provider Details

I. General information

NPI: 1689484123
Provider Name (Legal Business Name): JONATHON HUFF PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 MERIDIAN WAY STE 9
RICHMOND KY
40475-2876
US

IV. Provider business mailing address

PO BOX 932184
ATLANTA GA
31193-2184
US

V. Phone/Fax

Practice location:
  • Phone: 859-623-6336
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT009244
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: