MEDICARE: RYAN SCOTT TOLLIVER PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	4341	KY

General Provider Information

NPI Number	:	1346309218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN SCOTT TOLLIVER PT

Provider Business Mailing Address
First Line	:	2700 STANLEY GAULT PKWY STE 129
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-5176
Country	:	US
Telephone Number	:	502-253-4914
Fax Number	:	502-489-5751

Provider Business Practice Location Address
First Line	:	1400 CUMBERLAND FALLS HWY STE C
Second Line	:
City	:	CORBIN
State	:	KY
Zip	:	40701-2739
Country	:	US
Telephone Number	:	606-528-2149
Fax Number	:	606-528-2338

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2006
Last Update Date	:	12/04/2020

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