Provider Demographics
NPI:1861690208
Name:KING, KATHY JO (PTA)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:JO
Last Name:KING
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:1317 CLEARVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-3424
Mailing Address - Country:US
Mailing Address - Phone:615-758-9065
Mailing Address - Fax:
Practice Address - Street 1:VUMC 1215 21ST AVE S
Practice Address - Street 2:MEDICAL CENTER EAST SOUTH TOWER SUITE 3312
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-0001
Practice Address - Country:US
Practice Address - Phone:615-343-1207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA0000001881225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant