Provider Demographics
NPI:1013966191
Name:HANDSHOE, RON P
Entity Type:Individual
Prefix:
First Name:RON
Middle Name:P
Last Name:HANDSHOE
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 1:127 WOODFORD DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-9754
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:624 MAYSVILLE RD
Practice Address - Street 2:SUITE C
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-9767
Practice Address - Country:US
Practice Address - Phone:859-499-4351
Practice Address - Fax:859-499-4321
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY003272225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY8700142600Medicaid
KY5029503Medicare ID - Type UnspecifiedMEDICARE #