Basic Information
| Provider Information | |||||||||
| NPI: | 1952575235 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WESTERN KENTUCKY ORTHOPAEDIC ASSOCIATES PHYSICAL THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1777 ASHLEY CIR | ||||||||
| Address2: | |||||||||
| City: | BOWLING GREEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421043339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707930395 | ||||||||
| FaxNumber: | 2707930765 | ||||||||
| Practice Location | |||||||||
| Address1: | 1777 ASHLEY CIR | ||||||||
| Address2: | |||||||||
| City: | BOWLING GREEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421043339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707930395 | ||||||||
| FaxNumber: | 2707930765 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2008 | ||||||||
| LastUpdateDate: | 04/17/2008 | ||||||||
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| AuthorizedOfficialLastName: | VAUGHAN | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
| AuthorizedOfficialMiddleName: | MEREDITH | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2707930395 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WESTERN KENTUCKY ORTHOPAEDIC ASSOCIATES | ||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT-003526 | KY | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.