Provider Demographics
NPI:1639110323
Name:CAUDILL, STEPHANIE LAYNE (MSPT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LAYNE
Last Name:CAUDILL
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 LEESTOWN RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-2136
Mailing Address - Country:US
Mailing Address - Phone:859-296-6303
Mailing Address - Fax:859-296-6304
Practice Address - Street 1:1600 LEESTOWN RD
Practice Address - Street 2:SUITE 160
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511-2136
Practice Address - Country:US
Practice Address - Phone:859-296-6303
Practice Address - Fax:859-296-6304
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY003725225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000389770OtherANTHEM BCBS
KY0007162160OtherAETNA
KY0007162160OtherAETNA