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General NPI Number Information
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NPI Number | 1740810936
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Entity Type | Organization
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Legal Business Name | LEGACY PHYSICAL THERAPY
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Dates
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Enumeration Date | 01/16/2020
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Last Update Date | 06/30/2021
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Provider Practice Location Address
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Address Line | 237 E HIGHWAY 60
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City | HARDINSBURG
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State | KY
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Zip | 40143-4892
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Country | US
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Telephone | 859-229-2203
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Fax |
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Provider Business Mailing Address
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Address Line | 237 E HIGHWAY 60
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City | HARDINSBURG
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State | KY
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Zip | 40143-4892
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MATTHEW MATTINGLY
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Credential | MPT
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Telephone | 859-229-2203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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