Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | A00910 | KY |
NPI | 1003014846 |
---|---|
Provider Name | Mrs. Sharon Ford Fish |
First Address | Elizabethtown, KY 42701-7433 |
Second Address | Elizabethtown, KY 42701-2749 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2007 |
Last Update Date | 08/07/2007 |