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General NPI Number Information
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NPI Number | 1962427054
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Entity Type | Individual
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Provider Name | RENEE C HUMPHREY PHYSICAL THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 02/07/2022
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Provider Practice Location Address
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Address Line | 244 US HIGHWAY 68 E
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City | BENTON
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State | KY
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Zip | 42025-7568
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Country | US
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Telephone | 270-527-4322
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Fax | 270-252-7026
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Provider Business Mailing Address
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Address Line | 484 RIVERSIDE AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32202-4912
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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 |
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Name |
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Credential |
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Telephone |
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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 | 05004101A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 008462
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License Number State | KY
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