Provider Demographics
NPI:1083688212
Name:PHYSICAL THERAPY CLINIC PSC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY CLINIC PSC
Other - Org Name:PIKE COUNTY PHYSICAL THERAPY CLINIC, PSC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:C
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:606-432-8782
Mailing Address - Street 1:419 TOWN MOUNTAIN RD STE 108
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-1632
Mailing Address - Country:US
Mailing Address - Phone:606-432-8782
Mailing Address - Fax:606-432-8858
Practice Address - Street 1:419 TOWN MOUNTAIN RD STE 108
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1632
Practice Address - Country:US
Practice Address - Phone:606-432-8782
Practice Address - Fax:606-432-8858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000072916OtherANTHEM
KY000000072916OtherANTHEM