Individual
SHAUN VICKERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, MPT
Contact information
Practice address
425 ISLAND FORD ROAD, MADISONVILLE, KY 42431
(270) 825-0166
Mailing address
106 GENEVIEVE DR, MADISONVILLE, KY 42431-5806
(270) 836-6559
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
004425
KY
Other
Enumeration date
09/14/2018
Last updated
09/14/2018
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