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General NPI Number Information
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NPI Number | 1689297152
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Entity Type | Organization
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Legal Business Name | MANTOOTH PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 05/19/2020
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Last Update Date | 05/19/2020
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Provider Practice Location Address
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Address Line | 301 W WALNUT ST
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City | LEITCHFIELD
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State | KY
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Zip | 42754-1256
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Country | US
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Telephone | 270-589-1730
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Fax |
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Provider Business Mailing Address
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Address Line | 301 W WALNUT ST
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City | LEITCHFIELD
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State | KY
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Zip | 42754
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Country | US
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Telephone | 270-589-1730
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/OWNER
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Name | MRS. MARY VIVIAN MANTOOTH
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Credential | PT
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Telephone | 270-589-1730
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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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