Provider Demographics
NPI:1508389420
Name:HILL, CHRISTOPHER WARDIN (PTA)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:WARDIN
Last Name:HILL
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 1:260 RACE ST
Mailing Address - Street 2:
Mailing Address - City:SMITHS GROVE
Mailing Address - State:KY
Mailing Address - Zip Code:42171-8255
Mailing Address - Country:US
Mailing Address - Phone:270-597-7534
Mailing Address - Fax:
Practice Address - Street 1:220 WESTWOOD ST
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-1028
Practice Address - Country:US
Practice Address - Phone:270-651-3499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-23
Last Update Date:2017-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA03043225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant