Provider Demographics
NPI:1710487350
Name:MAYHORN, GREG MATTHEW
Entity Type:Individual
Prefix:MR
First Name:GREG
Middle Name:MATTHEW
Last Name:MAYHORN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 MCDAVID BLVD
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:KY
Mailing Address - Zip Code:41143-1603
Mailing Address - Country:US
Mailing Address - Phone:606-474-7835
Mailing Address - Fax:
Practice Address - Street 1:250 MCDAVID BLVD
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:KY
Practice Address - Zip Code:41143-1603
Practice Address - Country:US
Practice Address - Phone:606-474-7835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0047222251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics