Provider Demographics
NPI:1811961840
Name:ALGWYDON INC
Entity type:Organization
Organization Name:ALGWYDON INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GWYNN
Authorized Official - Middle Name:P
Authorized Official - Last Name:GANT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:502-350-0880
Mailing Address - Street 1:115 SOUTH SALEM DR
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004
Mailing Address - Country:US
Mailing Address - Phone:502-350-0880
Mailing Address - Fax:502-350-3640
Practice Address - Street 1:115 SOUTH SALEM DR
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004
Practice Address - Country:US
Practice Address - Phone:502-350-0880
Practice Address - Fax:502-350-3640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY87900320Medicaid
X58754Medicare UPIN
KY8838Medicare ID - Type Unspecified