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General NPI Number Information
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NPI Number | 1861734840
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Entity Type | Organization
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Legal Business Name | PENNYRILE PHYSICAL THERAPY
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Dates
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Enumeration Date | 03/18/2013
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Last Update Date | 03/18/2013
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Provider Practice Location Address
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Address Line | 101 FORBES DR
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City | HOPKINSVILLE
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State | KY
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Zip | 42240-7200
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Country | US
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Telephone | 270-889-9996
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Fax | 270-889-9993
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Provider Business Mailing Address
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Address Line | 101 FORBES DR
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City | HOPKINSVILLE
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State | KY
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Zip | 42240-7200
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Country | US
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Telephone | 270-889-9996
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Fax | 270-889-9993
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Authorized Official
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Title or Position | OWNER & MANAGER
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Name | MRS. KETKI PRAKASH SHAH
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Credential | P.T.
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Telephone | 270-889-9996
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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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