Provider Demographics
NPI:1104396449
Name:CORE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:CORE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODWARD
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:859-806-7218
Mailing Address - Street 1:127 ALBEN BARKLEY DR STE C
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-4402
Mailing Address - Country:US
Mailing Address - Phone:270-908-0294
Mailing Address - Fax:270-908-0296
Practice Address - Street 1:127 ALBEN BARKLEY DR STE C
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-4402
Practice Address - Country:US
Practice Address - Phone:270-908-0294
Practice Address - Fax:270-908-0296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1942462403OtherNPI
KY005283OtherPHYSICAL THERAPIST LICENSE NUMBER