Provider Demographics
NPI:1871602623
Name:FLAHERTY, JONI (PT)
Entity type:Individual
Prefix:MRS
First Name:JONI
Middle Name:
Last Name:FLAHERTY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 PARK PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-5485
Mailing Address - Country:US
Mailing Address - Phone:270-478-4366
Mailing Address - Fax:270-478-4367
Practice Address - Street 1:605 PARK PLAZA DR
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-5485
Practice Address - Country:US
Practice Address - Phone:270-478-4366
Practice Address - Fax:270-478-4367
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY002305225100000X
IN05010231A225100000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY87001780Medicaid
KY8915Medicare PIN
INM400015752Medicare PIN