Healthcare Provider Details

I. General information

NPI: 1932700739
Provider Name (Legal Business Name): HAYDEN ELIZABETH MIGNEAULT DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 FARRIS PARKS BLVD
RICHMOND KY
40475-7650
US

IV. Provider business mailing address

109 WIND HAVEN DR STE 100
NICHOLASVILLE KY
40356-8010
US

V. Phone/Fax

Practice location:
  • Phone: 859-353-3666
  • Fax: 859-448-7077
Mailing address:
  • Phone: 859-224-2273
  • Fax: 859-224-4675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number008119
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number008119
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: