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General NPI Number Information
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NPI Number | 1134572993
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Entity Type | Organization
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Legal Business Name | GME ENTERPRISES PSC
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Dates
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Enumeration Date | 07/18/2016
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Last Update Date | 07/18/2016
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Provider Practice Location Address
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Address Line | 1092 DUVAL ST SUITE 210
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City | LEXINGTON
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State | KY
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Zip | 40515-8908
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Country | US
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Telephone | 859-271-1092
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Fax | 888-521-2925
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Provider Business Mailing Address
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Address Line | 606 LANE ALLEN RD
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City | LEXINGTON
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State | KY
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Zip | 40504-3507
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Country | US
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Telephone | 740-398-3254
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. GRACE E MILLER
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Credential | PT
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Telephone | 740-398-3254
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 005900
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License Number State | KY
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