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General NPI Number Information
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NPI Number | 1144775453
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Entity Type | Organization
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Legal Business Name | PHAUP PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 08/17/2016
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Last Update Date | 08/17/2016
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Provider Practice Location Address
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Address Line | 95 YMCA DR SUITE A
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City | MADISONVILLE
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State | KY
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Zip | 42431-9035
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Country | US
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Telephone | 270-452-2188
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Fax | 270-245-2995
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Provider Business Mailing Address
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Address Line | 95 YMCA DR SUITE A
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City | MADISONVILLE
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State | KY
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Zip | 42431-9035
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Country | US
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Telephone | 270-452-2188
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Fax | 270-245-2995
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Authorized Official
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Title or Position | OWNER
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Name | MS. MARY SELENA PHAUP
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Credential | PT
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Telephone | 270-452-2188
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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 | 1050
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License Number State | KY
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