Provider Demographics
NPI:1154514826
Name:HANCOCK PHYSICAL THERAPY SPECIALISTS, LLC.
Entity type:Organization
Organization Name:HANCOCK PHYSICAL THERAPY SPECIALISTS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:270-719-9407
Mailing Address - Street 1:755 EVERETT LN
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-9520
Mailing Address - Country:US
Mailing Address - Phone:270-719-9407
Mailing Address - Fax:270-707-7377
Practice Address - Street 1:1222 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-4968
Practice Address - Country:US
Practice Address - Phone:270-719-9407
Practice Address - Fax:270-707-7377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY003647261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00444OtherMEDICARE GROUP #