Provider Demographics
NPI:1013194943
Name:POWELL, KATHLEEN MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:POWELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:KATHLEEN
Other - Middle Name:MARIE
Other - Last Name:THORNTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1425 MC FARLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ROSSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30741
Mailing Address - Country:US
Mailing Address - Phone:706-861-0863
Mailing Address - Fax:706-861-3965
Practice Address - Street 1:1425 MC FARLAND AVE
Practice Address - Street 2:
Practice Address - City:ROSSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30741
Practice Address - Country:US
Practice Address - Phone:706-861-0863
Practice Address - Fax:706-861-3965
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT003413225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist