Provider Demographics
NPI:1770955882
Name:BBN PHYSICAL THERAPY, INC
Entity type:Organization
Organization Name:BBN PHYSICAL THERAPY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTOPHER
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:WINDERS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:843-991-8333
Mailing Address - Street 1:818 MONTCLAIR DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-2263
Mailing Address - Country:US
Mailing Address - Phone:859-654-0119
Mailing Address - Fax:859-652-3903
Practice Address - Street 1:162 OLD TODDS RD
Practice Address - Street 2:UNIT 260
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1336
Practice Address - Country:US
Practice Address - Phone:859-654-0119
Practice Address - Fax:859-652-3903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY006708261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ339918422Medicare PIN