Provider Demographics
NPI:1477710770
Name:HOWARD, JIMMIE (PTA)
Entity Type:Individual
Prefix:
First Name:JIMMIE
Middle Name:
Last Name:HOWARD
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:RT 1 BOX 102
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40977
Mailing Address - Country:US
Mailing Address - Phone:606-337-7071
Mailing Address - Fax:606-337-2907
Practice Address - Street 1:RT 1 BOX 102
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:KY
Practice Address - Zip Code:40977
Practice Address - Country:US
Practice Address - Phone:606-337-7071
Practice Address - Fax:606-337-2907
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA01312225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant