Kevin Bradley Creech

Key facts

NPI

1578813416

Entity type

Individual (NPI type 1)

Primary specialty

Physical Therapy Assistant 225200000X

License

A02794 (KY)

Practice address

81 Ball Park Rd
Harlan, KY 40831-1701

Phone

(606) 573-8210

NPI assigned

Sep 19, 2012

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 19, 2012.

{
    "created_epoch": "1348012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348012800000",
    "number": "1578813416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "81 BALL PARK RD",
            "city": "HARLAN",
            "state": "KY",
            "postal_code": "408311701",
            "telephone_number": "606-573-8210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "81 BALL PARK RD",
            "city": "HARLAN",
            "state": "KY",
            "postal_code": "408311701",
            "telephone_number": "606-573-8210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CREECH",
        "first_name": "KEVIN",
        "middle_name": "BRADLEY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-09-19",
        "last_updated": "2012-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "KY",
            "license": "A02794",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Harlan, KY · Physical Therapy Assistant in Kentucky