Provider Demographics
NPI:1013003029
Name:ESCOBAR, DAVID D (PT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:D
Last Name:ESCOBAR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 TRADEPARK DR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-3428
Mailing Address - Country:US
Mailing Address - Phone:606-678-5708
Mailing Address - Fax:606-678-4336
Practice Address - Street 1:117 TRADEPARK DR
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-3428
Practice Address - Country:US
Practice Address - Phone:606-678-5708
Practice Address - Fax:606-678-4336
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY002008225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1174914OtherCHA PROVIDER #
KY650019563OtherRR MEDICARE #
KY000000179369OtherBLUE CROSS BLUE SHIELD
KY87020087Medicaid
KY87020087Medicaid