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General NPI Number Information
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NPI Number | 1497230510
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Entity Type | Individual
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Provider Name | KELLY MODAFF PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 09/25/2018
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Last Update Date | 09/25/2018
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Provider Practice Location Address
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Address Line | 108 DIAGNOSTIC DR
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City | FRANKFORT
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State | KY
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Zip | 40601-6556
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Country | US
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Telephone | 502-607-8910
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Fax |
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Provider Business Mailing Address
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Address Line | 1646 LUCIA AVE APT 1
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City | LOUISVILLE
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State | KY
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Zip | 40204-1346
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Country | US
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Telephone | 606-356-5320
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Fax |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | TP2018118
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License Number State | KY
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