Provider Demographics
NPI:1912946989
Name:CENTRAL KENTUCKY PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:CENTRAL KENTUCKY PHYSICAL THERAPY INC
Other - Org Name:LAWRENCEBURG PHYSICAL THERAPY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER - PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:BRISCOE
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:502-839-9755
Mailing Address - Street 1:1100 GLENSBORO ROAD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40342-1013
Mailing Address - Country:US
Mailing Address - Phone:502-839-9755
Mailing Address - Fax:502-839-9763
Practice Address - Street 1:1100 GLENSBORO ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:LAWRENCEBURG
Practice Address - State:KY
Practice Address - Zip Code:40342-1013
Practice Address - Country:US
Practice Address - Phone:502-839-9755
Practice Address - Fax:502-839-9763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY002414225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY186550Medicare ID - Type UnspecifiedPHYSICAL THERAPY