Basic Information
Provider Information
NPI: 1366767733
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: POHLMAN
FirstName: KRISTY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 7544
Address2:  
City: PADUCAH
State: KY
PostalCode: 420027544
CountryCode: US
TelephoneNumber: 4192963382
FaxNumber:  
Practice Location
Address1: 501 N 3RD ST
Address2:  
City: PADUCAH
State: KY
PostalCode: 420010749
CountryCode: US
TelephoneNumber: 2704449661
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/29/2010
LastUpdateDate: 01/31/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X005597KYY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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