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General NPI Number Information
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NPI Number | 1639775463
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Entity Type | Organization
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Legal Business Name | CHANGE OF PACE PHYSICAL THERAPY
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Dates
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Enumeration Date | 12/08/2020
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Last Update Date | 03/24/2021
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Provider Practice Location Address
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Address Line | 725 HARVARD DR
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City | OWENSBORO
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State | KY
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Zip | 42301-6185
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Country | US
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Telephone | 270-231-6868
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 298
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City | UTICA
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State | KY
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Zip | 42376-0298
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Country | US
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Telephone | 270-231-6868
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TAMMY S. CUMMINGS
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Credential | PT
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Telephone | 270-231-6868
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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 |
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License Number State |
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