Provider Demographics
NPI:1306537386
Name:MAY, WILLIE D
Entity type:Individual
Prefix:
First Name:WILLIE
Middle Name:D
Last Name:MAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 KELCH LN
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:KY
Mailing Address - Zip Code:40033-8622
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 S HUBBARDS LN
Practice Address - Street 2:
Practice Address - City:ST MATTHEWS
Practice Address - State:KY
Practice Address - Zip Code:40207-3993
Practice Address - Country:US
Practice Address - Phone:502-896-1759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA03417225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant