Provider Demographics
NPI:1902146467
Name:CARLSON, KAITLIN ANSLEY (DPT)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:ANSLEY
Last Name:CARLSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5290 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-2444
Mailing Address - Country:US
Mailing Address - Phone:931-489-2022
Mailing Address - Fax:931-489-2036
Practice Address - Street 1:2823 GREYSTN COM BLVD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-2660
Practice Address - Country:US
Practice Address - Phone:205-453-9400
Practice Address - Fax:205-453-9410
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH6725225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist