Provider Demographics
NPI:1104362375
Name:POWELL, PATRICIA (LMT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5107 JONAR CT
Mailing Address - Street 2:
Mailing Address - City:FERN CREEK
Mailing Address - State:KY
Mailing Address - Zip Code:40291-1517
Mailing Address - Country:US
Mailing Address - Phone:502-276-5711
Mailing Address - Fax:
Practice Address - Street 1:6340 W HIGHWAY 146
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014-8839
Practice Address - Country:US
Practice Address - Phone:502-276-5711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4616225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist