Provider Demographics
NPI:1922303882
Name:MAYSVILLE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:MAYSVILLE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:KEY
Authorized Official - Last Name:MCKAY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:606-759-4719
Mailing Address - Street 1:1925 OLD MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MAYSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41056-8984
Mailing Address - Country:US
Mailing Address - Phone:606-759-4719
Mailing Address - Fax:
Practice Address - Street 1:1925 OLD MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-8984
Practice Address - Country:US
Practice Address - Phone:606-759-4719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-24
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT001912261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy