Provider Demographics
NPI:1306584560
Name:ROADEN, FAITH C (PT)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:C
Last Name:ROADEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3054 FENDER RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:KY
Mailing Address - Zip Code:41059-9446
Mailing Address - Country:US
Mailing Address - Phone:859-628-9926
Mailing Address - Fax:
Practice Address - Street 1:8726 US 42
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-9625
Practice Address - Country:US
Practice Address - Phone:859-301-2663
Practice Address - Fax:859-817-7848
Is Sole Proprietor?:No
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY008515225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY008515OtherKENTUCKY BOARD OF PHYSICAL THERAPY