Provider Demographics
NPI:1437108818
Name:PHOENIX PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:PHOENIX PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SCHELLING
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:859-236-4686
Mailing Address - Street 1:122 DANIEL DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-2527
Mailing Address - Country:US
Mailing Address - Phone:859-236-4686
Mailing Address - Fax:859-236-4624
Practice Address - Street 1:122 DANIEL DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-2527
Practice Address - Country:US
Practice Address - Phone:859-236-4686
Practice Address - Fax:859-236-4624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5377225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0743202Medicare ID - Type UnspecifiedMATTHEW J. SCHELLING, PT
KY7432Medicare ID - Type UnspecifiedMCR PRACTICE ID
KY0743201Medicare PIN