Provider Demographics
NPI:1497006068
Name:HARDESTY, CHARLES J (PT)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:J
Last Name:HARDESTY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 BLUE LICKS RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2216
Mailing Address - Country:US
Mailing Address - Phone:502-599-6938
Mailing Address - Fax:
Practice Address - Street 1:102 WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-1917
Practice Address - Country:US
Practice Address - Phone:859-881-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist