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General NPI Number Information
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NPI Number | 1104165968
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Entity Type | Organization
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Legal Business Name | EASTERN KENTUCKY PHYSICAL THERAPY, PSC
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Dates
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Enumeration Date | 02/13/2013
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Last Update Date | 02/13/2013
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Provider Practice Location Address
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Address Line | 637 N LAKE DR
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City | PRESTONSBURG
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State | KY
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Zip | 41653-1280
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Country | US
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Telephone | 606-889-0838
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Fax | 606-889-0498
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Provider Business Mailing Address
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Address Line | 637 N LAKE DR
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City | PRESTONSBURG
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State | KY
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Zip | 41653-1280
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Country | US
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Telephone | 606-889-0838
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Fax | 606-889-0498
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | GWENDOLYN HALL
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Credential | PT
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Telephone | 606-889-0838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 1908
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License Number State | KY
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