Provider Demographics
NPI:1225543531
Name:PARTIN, CHARLES BOBBY (ATC, LAT, ITAT)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:BOBBY
Last Name:PARTIN
Suffix:
Gender:M
Credentials:ATC, LAT, ITAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 TURKEY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40977-7894
Mailing Address - Country:US
Mailing Address - Phone:606-670-2700
Mailing Address - Fax:
Practice Address - Street 1:103 S PINE ST
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:KY
Practice Address - Zip Code:40977-1610
Practice Address - Country:US
Practice Address - Phone:606-254-2075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT11772255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYAT117OtherKENTUCKY BOARD OF MEDICAL LICENSURE