Provider Demographics
NPI:1619104296
Name:KENTUCKY HAND & PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:KENTUCKY HAND & PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCGOVERN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, CPC
Authorized Official - Phone:859-264-8866
Mailing Address - Street 1:151 N EAGLE CREEK DR
Mailing Address - Street 2:STE 400
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1889
Mailing Address - Country:US
Mailing Address - Phone:859-264-8866
Mailing Address - Fax:859-264-1167
Practice Address - Street 1:101 WINDSOR PATH
Practice Address - Street 2:STE 2
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324
Practice Address - Country:US
Practice Address - Phone:502-863-1674
Practice Address - Fax:502-863-1676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY07184OtherMEDICARE/GROUP
KY07184OtherMEDICARE/GROUP