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General NPI Number Information
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NPI Number | 1902770530
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Entity Type | Organization
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Legal Business Name | PHYSICAL THERAPY ASSOCIATES INC
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Dates
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Enumeration Date | 10/06/2025
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 141 EASTBROOKE POINTE DR E
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City | MT WASHINGTON
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State | KY
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Zip | 40047-7383
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Country | US
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Telephone | 502-251-5145
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Fax | 502-251-5130
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Provider Business Mailing Address
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Address Line | 614 WESTPORT RD STE A
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-3832
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Country | US
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Telephone | 270-234-1569
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Fax | 270-234-8197
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Authorized Official
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Title or Position | OWNER
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Name | GUY ROBERT WALLACE
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Credential |
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Telephone | 270-234-1569
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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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