Provider Demographics
NPI:1629166525
Name:HOWARD, ELIZABETH MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARIE
Last Name:HOWARD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 GALAHAD DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9416
Mailing Address - Country:US
Mailing Address - Phone:859-312-5145
Mailing Address - Fax:
Practice Address - Street 1:100 TRADE ST STE B
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511-2634
Practice Address - Country:US
Practice Address - Phone:859-455-8430
Practice Address - Fax:859-455-8431
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA02238225200000X
IN06003266A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant