Individual
MARY SELENA PHAUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1015 COLLEGE DR, MADISONVILLE, KY 42431-9189
(270) 452-2188
(270) 245-2995
Mailing address
1015 COLLEGE DR, MADISONVILLE, KY 42431-9189
(270) 452-2188
(270) 245-2995
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
001050
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001050
KENTUCKY STATE LICENSE
KY
Enumeration date
07/30/2007
Last updated
05/26/2021
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