Provider Demographics
NPI:1659258259
Name:ROSE, KYANNE (PT)
Entity type:Individual
Prefix:
First Name:KYANNE
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 306556
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6556
Mailing Address - Country:US
Mailing Address - Phone:931-221-4743
Mailing Address - Fax:931-552-0999
Practice Address - Street 1:1000 S GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8118
Practice Address - Country:US
Practice Address - Phone:931-221-4743
Practice Address - Fax:931-552-0999
Is Sole Proprietor?:No
Enumeration Date:2025-08-18
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16745225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist