Provider Demographics
NPI:1194863696
Name:SURRETT, PHILLIP KEVIN (PTA)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:KEVIN
Last Name:SURRETT
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 FOUNTAIN CT
Mailing Address - Street 2:SUITE 325
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1895
Mailing Address - Country:US
Mailing Address - Phone:859-263-0595
Mailing Address - Fax:859-263-0385
Practice Address - Street 1:230 FOUNTAIN CT
Practice Address - Street 2:SUITE 325
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1895
Practice Address - Country:US
Practice Address - Phone:859-263-0595
Practice Address - Fax:859-263-0385
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA01216225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant