Provider Demographics
NPI:1093752859
Name:LECOMPTE, SHERRYN G (PT)
Entity Type:Individual
Prefix:MRS
First Name:SHERRYN
Middle Name:G
Last Name:LECOMPTE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 MACK WALTERS RD
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-1738
Mailing Address - Country:US
Mailing Address - Phone:502-633-2443
Mailing Address - Fax:502-633-3126
Practice Address - Street 1:72 MACK WALTERS RD
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-1738
Practice Address - Country:US
Practice Address - Phone:502-633-2443
Practice Address - Fax:502-633-3126
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT-001145225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY650010878OtherRAILROAD MEDICARE
KY87011458Medicaid
KY1038570001Medicare NSC
KY0612401Medicare PIN