Healthcare Provider Details

I. General information

NPI: 1306537386
Provider Name (Legal Business Name): WILLIE D MAY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S HUBBARDS LN
ST MATTHEWS KY
40207-3993
US

IV. Provider business mailing address

412 KELCH LN
LEBANON KY
40033-8622
US

V. Phone/Fax

Practice location:
  • Phone: 502-896-1759
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA03417
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: