| Organization Name: | ELIZABETHTOWN PHYSICAL THERAPY PSC |
| NPI Number: | 1457352007 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL E TARVIN (VICE PRESIDENT) |
| Mailing Address: | 815 Fairway Dr Suite C Brandenburg |
| State: | KY US |
| Postal Code: | 40108 |
| Phone Number: | 2704223366 |
| Fax Number: | 2704223378 |
| NPI Enumeration Date: | 08/04/2005 |
| NPI Last Update Date: | 03/11/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | 10/10/2006 |
| NPI Reactivation Date: | 10/30/2006 |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |