Basic Information
| Provider Information | |||||||||
| NPI: | 1487001384 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICAL THERAPY ASSOCIATES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 403 N MILES ST | ||||||||
| Address2: | |||||||||
| City: | ELIZABETHTOWN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 427011834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2703609129 | ||||||||
| FaxNumber: | 2702348197 | ||||||||
| Practice Location | |||||||||
| Address1: | 505 HIGH STREET | ||||||||
| Address2: | |||||||||
| City: | BRANDENBURG | ||||||||
| State: | KY | ||||||||
| PostalCode: | 401081317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2703609129 | ||||||||
| FaxNumber: | 2702348197 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2016 | ||||||||
| LastUpdateDate: | 05/20/2016 | ||||||||
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| AuthorizedOfficialLastName: | WALLACE | ||||||||
| AuthorizedOfficialFirstName: | GUY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2703609129 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.