Provider Demographics
NPI:1871727289
Name:FORKER, SLADE AARON (PT)
Entity type:Individual
Prefix:
First Name:SLADE
Middle Name:AARON
Last Name:FORKER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3135 ZION RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-9204
Mailing Address - Country:US
Mailing Address - Phone:270-826-0028
Mailing Address - Fax:270-826-7424
Practice Address - Street 1:3135 ZION RD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-9204
Practice Address - Country:US
Practice Address - Phone:270-826-0028
Practice Address - Fax:270-826-7424
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005148225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist