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General NPI Number Information
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NPI Number | 1477710770
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Entity Type | Individual
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Provider Name | JIMMIE HOWARD PTA
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Gender | Male
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Dates
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Enumeration Date | 05/22/2008
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Last Update Date | 05/22/2008
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Provider Practice Location Address
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Address Line | RT 1 BOX 102
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City | PINEVILLE
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State | KY
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Zip | 40977
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Country | US
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Telephone | 606-337-7071
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Fax | 606-337-2907
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Provider Business Mailing Address
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Address Line | RT 1 BOX 102
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City | PINEVILLE
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State | KY
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Zip | 40977
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Country | US
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Telephone | 606-337-7071
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Fax | 606-337-2907
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A01312
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License Number State | KY
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