Individual
THOMAS LEO MUDD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
875 PENNSYLVANIA AVE STE A, BARDSTOWN, KY 40004-2529
(502) 349-6961
Mailing address
608 BRIAR CLIFF AVE, BARDSTOWN, KY 40004-8941
(502) 460-3868
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
007461
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HVNAN0707355
ANTHEM
—
Enumeration date
08/01/2018
Last updated
08/01/2018
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