Provider Demographics
NPI:1871610402
Name:CHRIST CENTERED PHYSICAL THERAPY FOR APPALACHIA INC.
Entity type:Organization
Organization Name:CHRIST CENTERED PHYSICAL THERAPY FOR APPALACHIA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAIDEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:606-347-2398
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:FRAKES
Mailing Address - State:KY
Mailing Address - Zip Code:40940-0337
Mailing Address - Country:US
Mailing Address - Phone:606-347-2398
Mailing Address - Fax:606-337-8232
Practice Address - Street 1:133 HENDERSON CHURCH RD
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:KY
Practice Address - Zip Code:40977-9135
Practice Address - Country:US
Practice Address - Phone:606-269-9834
Practice Address - Fax:270-266-3757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT00001776225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5020201Medicare ID - Type Unspecified