MEDICARE: MRS. LYNN KIBBONS COLLINS 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	01189	KY

General Provider Information

NPI Number	:	1487652848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LYNN KIBBONS COLLINS PT

Provider Business Mailing Address
First Line	:	5027 ATWOOD DR STE 2B
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-8322
Country	:	US
Telephone Number	:	859-625-0001
Fax Number	:	859-625-1109

Provider Business Practice Location Address
First Line	:	116 MERIDIAN WAY STE 9
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-2876
Country	:	US
Telephone Number	:	859-626-3131
Fax Number	:	859-625-1109

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

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	03/01/2013

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