Provider Demographics
NPI:1356987945
Name:KEPHART, CHRISTIAN (LMT, CCT, ADS)
Entity type:Individual
Prefix:MS
First Name:CHRISTIAN
Middle Name:
Last Name:KEPHART
Suffix:
Gender:F
Credentials:LMT, CCT, ADS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4506 IRVINE RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-8641
Mailing Address - Country:US
Mailing Address - Phone:859-644-8993
Mailing Address - Fax:
Practice Address - Street 1:3882 MALL RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-4438
Practice Address - Country:US
Practice Address - Phone:859-644-8993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY245288225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist