Provider Demographics
NPI:1386677599
Name:WOODFORD PHYSICAL THERAPY, PSC
Entity Type:Organization
Organization Name:WOODFORD PHYSICAL THERAPY, PSC
Other - Org Name:FRANKFORT PHYSICAL THERAPY, PSC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SPALDING
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:859-879-8898
Mailing Address - Street 1:115 C CROSSFIELD DR.
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383
Mailing Address - Country:US
Mailing Address - Phone:859-879-8898
Mailing Address - Fax:859-879-8458
Practice Address - Street 1:115 C CROSSFIELD DR.
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383
Practice Address - Country:US
Practice Address - Phone:859-879-8898
Practice Address - Fax:859-879-8458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY225100000X
261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6424Medicare PIN