Healthcare Provider Details

I. General information

NPI: 1124126057
Provider Name (Legal Business Name): SHELBYVILLE PHYSICAL THERAPY & SPINE CARE CENTER, P.S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 10/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 MACK WALTERS RD
SHELBYVILLE KY
40065-1738
US

IV. Provider business mailing address

72 MACK WALTERS RD
SHELBYVILLE KY
40065-1738
US

V. Phone/Fax

Practice location:
  • Phone: 502-633-2443
  • Fax: 502-633-3126
Mailing address:
  • Phone: 502-633-2443
  • Fax: 502-633-3126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: SHERRYN G LECOMPTE
Title or Position: OWNER
Credential: P.T.
Phone: 502-633-2443