Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | ||
Y | 2251P0200X | Physical Therapist - Pediatrics | 008126 | KY |
NPI | 1063011690 |
---|---|
Provider Name | Shelby Price |
First Address | Lexington, KY 40515-5943 |
Second Address | Lexington, KY 40503-1601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2020 |
Last Update Date | 06/01/2021 |