Provider Demographics
NPI:1942275607
Name:PHYSICAL THERAPY CLINIC PSC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY CLINIC PSC
Other - Org Name:PIKE COUNTY PHYSICAL THERAPY CLINIC, PSC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:C
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:606-237-4477
Mailing Address - Street 1:PHYSICAL THERAPY CLINIC PSC
Mailing Address - Street 2:419 TOWN MOUNTAIN RD STE 108
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-1632
Mailing Address - Country:US
Mailing Address - Phone:606-432-8782
Mailing Address - Fax:606-432-8858
Practice Address - Street 1:275 MALL ROAD
Practice Address - Street 2:SUITE 1A
Practice Address - City:SOUTH WILLIAMSON
Practice Address - State:KY
Practice Address - Zip Code:41503-1632
Practice Address - Country:US
Practice Address - Phone:606-237-4477
Practice Address - Fax:606-237-4475
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYSICAL THERAPY CLINIC PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-17
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000072916OtherANTHEM
KY0075Medicare PIN