Provider Demographics
NPI:1851619498
Name:PREMIER PHYSICAL THERAPY NV, LLC
Entity Type:Organization
Organization Name:PREMIER PHYSICAL THERAPY NV, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:615-308-6830
Mailing Address - Street 1:PO BOX 313
Mailing Address - Street 2:
Mailing Address - City:KEVIL
Mailing Address - State:KY
Mailing Address - Zip Code:42053-0313
Mailing Address - Country:US
Mailing Address - Phone:270-462-8252
Mailing Address - Fax:270-462-8253
Practice Address - Street 1:203 KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:KEVIL
Practice Address - State:KY
Practice Address - Zip Code:42053-8976
Practice Address - Country:US
Practice Address - Phone:270-462-8252
Practice Address - Fax:270-462-8253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004193225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty