Healthcare Provider Details

I. General information

NPI: 1992685655
Provider Name (Legal Business Name): DYLAN MATTHEW WALDROP PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W MAPLE ST
SCOTTSVILLE KY
42164-1134
US

IV. Provider business mailing address

250 PARK ST
BOWLING GREEN KY
42101-1760
US

V. Phone/Fax

Practice location:
  • Phone: 270-239-6640
  • Fax:
Mailing address:
  • Phone: 270-796-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number009403
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: