Basic Information
Provider Information
NPI: 1760659494
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NESTOR
FirstName: DAVID
MiddleName: EARL
NamePrefix:  
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1052 ALBERT LN
Address2:  
City: LEXINGTON
State: KY
PostalCode: 405141029
CountryCode: US
TelephoneNumber: 8592244298
FaxNumber:  
Practice Location
Address1: 1101 VETERANS DR
Address2:  
City: LEXINGTON
State: KY
PostalCode: 405022235
CountryCode: US
TelephoneNumber: 8592334511
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/12/2008
LastUpdateDate: 05/12/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2251E1300XPT-002967KYY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical

No ID Information.


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