Provider Demographics
NPI:1013634492
Name:SHORT, NICHOLAS HUNTER
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:HUNTER
Last Name:SHORT
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:PO BOX 1085
Mailing Address - Street 2:
Mailing Address - City:VIPER
Mailing Address - State:KY
Mailing Address - Zip Code:41774-0085
Mailing Address - Country:US
Mailing Address - Phone:606-438-3446
Mailing Address - Fax:
Practice Address - Street 1:1040 US HIGHWAY 127 S
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4326
Practice Address - Country:US
Practice Address - Phone:502-875-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-26
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA042641225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant