Provider Demographics
NPI:1104928969
Name:VALENTINE, EDWARD L III (PT)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:L
Last Name:VALENTINE
Suffix:III
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 1:195 COMMERCIAL DR
Mailing Address - Street 2:STE 100
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40744-5234
Mailing Address - Country:US
Mailing Address - Phone:606-657-5111
Mailing Address - Fax:606-657-2354
Practice Address - Street 1:195 COMMERCIAL DR STE 100
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40744-5234
Practice Address - Country:US
Practice Address - Phone:606-657-5111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
KY004527225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist