=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073710042
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KARI LYNN MCBRIDE PTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 509 N CARRIER ST
-----------------------------------------------------
City | MORGANFIELD
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42437-1201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-389-3513
-----------------------------------------------------
Fax | 270-389-4706
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5100 JEFFRIES LN
-----------------------------------------------------
City | NEWBURGH
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47630-3053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-490-6691
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | AOO834
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------