Provider Demographics
NPI:1932647161
Name:CREEVY, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:CREEVY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 BARNES RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:41097-9483
Mailing Address - Country:US
Mailing Address - Phone:859-824-8217
Mailing Address - Fax:859-824-8249
Practice Address - Street 1:300 BARNES RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:KY
Practice Address - Zip Code:41097-9483
Practice Address - Country:US
Practice Address - Phone:859-824-8217
Practice Address - Fax:859-824-8249
Is Sole Proprietor?:No
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY000431225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist