Basic Information
| Provider Information | |||||||||
| NPI: | 1053363614 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KENTUCKY HAND AND PHYSICAL THERAPY PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 151 N EAGLE CREEK DR | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405091889 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592648866 | ||||||||
| FaxNumber: | 8592641167 | ||||||||
| Practice Location | |||||||||
| Address1: | 151 N EAGLE CREEK DR | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405091889 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592648866 | ||||||||
| FaxNumber: | 8592641167 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 03/30/2011 | ||||||||
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| AuthorizedOfficialLastName: | WILLOUGHBY | ||||||||
| AuthorizedOfficialFirstName: | JASON | ||||||||
| AuthorizedOfficialMiddleName: | ALEXANDER | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 8592648866 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MHS, OTR/L, CHT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | KY | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.