Basic Information
| Provider Information | |||||||||
| NPI: | 1538537758 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOARD | ||||||||
| FirstName: | JEROME | ||||||||
| MiddleName: | EARL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2510 IL 145 RD | ||||||||
| Address2: | |||||||||
| City: | METROPOLIS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 629604929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6185244538 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4747 ALBEN BARKLEY DR | ||||||||
| Address2: | |||||||||
| City: | PADUCAH | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420016789 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2704449661 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2015 | ||||||||
| LastUpdateDate: | 09/03/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT-002068 | KY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.