Basic Information
| Provider Information | |||||||||
| NPI: | 1912946989 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CENTRAL KENTUCKY PHYSICAL THERAPY INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LAWRENCEBURG PHYSICAL THERAPY INC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 GLENSBORO ROAD | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | LAWRENCEBURG | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403421013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028399755 | ||||||||
| FaxNumber: | 5028399763 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 GLENSBORO ROAD | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | LAWRENCEBURG | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403421013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028399755 | ||||||||
| FaxNumber: | 5028399763 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BRISCOE | ||||||||
| AuthorizedOfficialFirstName: | TRACY | ||||||||
| AuthorizedOfficialMiddleName: | KENT | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER - PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 5028399755 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | PHYSICAL THERAPIST | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 002414 | KY | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.