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General NPI Number Information
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NPI Number | 1215116603
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Entity Type | Organization
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Legal Business Name | BIG SANDY PHYSICAL THERAPY
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Dates
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Enumeration Date | 11/01/2007
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Last Update Date | 11/01/2007
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Provider Practice Location Address
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Address Line | 83 DEWEY ST
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City | PRESTONSBURG
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State | KY
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Zip | 41653-7923
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Country | US
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Telephone | 606-886-9888
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Fax | 606-886-9416
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Provider Business Mailing Address
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Address Line | 83 DEWEY ST
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City | PRESTONSBURG
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State | KY
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Zip | 41653-7923
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Country | US
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Telephone | 606-886-9888
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Fax | 606-886-9416
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Authorized Official
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Title or Position | PRESIDENT/ PHYSICAL THERAPIST
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Name | MRS. SANDRA JOAN ROBERTS
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Credential | RN, BSN, PT
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Telephone | 606-886-9888
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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 | 002279
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License Number State | KY
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