Provider Demographics
NPI:1588732689
Name:TUG VALLEY PHYSICAL THERAPY
Entity type:Organization
Organization Name:TUG VALLEY PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HAZEL
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:FERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:606-237-0004
Mailing Address - Street 1:411 CENTRAL AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SOUTH WILLIAMSON
Mailing Address - State:KY
Mailing Address - Zip Code:41503-4149
Mailing Address - Country:US
Mailing Address - Phone:606-237-0004
Mailing Address - Fax:606-237-0330
Practice Address - Street 1:411 CENTRAL AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:SOUTH WILLIAMSON
Practice Address - State:KY
Practice Address - Zip Code:41503-4149
Practice Address - Country:US
Practice Address - Phone:606-237-0004
Practice Address - Fax:606-237-0330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810006362Medicaid
KY8776Medicare PIN
KYCG9052Medicare PIN