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General NPI Number Information
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NPI Number | 1649711565
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Entity Type | Organization
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Legal Business Name | TOUGH LITTLE CHAMPIONS PEDIATRIC PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 03/10/2017
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Last Update Date | 03/19/2021
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Provider Practice Location Address
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Address Line | 426 SILK OAK DR
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-5523
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Country | US
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Telephone | 270-282-9229
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Fax |
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Provider Business Mailing Address
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Address Line | 426 SILK OAK DR
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-5523
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Country | US
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Telephone | 270-304-6981
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | TRISHA LYNN CAMPBELL
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Credential | D.P.T.
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Telephone | 270-282-9229
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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 | 006053
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License Number State | KY
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