Provider Demographics
NPI:1033663422
Name:BOLTON, KATHY WILBOURN (PT)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:WILBOURN
Last Name:BOLTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:JO
Other - Last Name:WILBOURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:112 BRADFORD BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:GORDONSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38563-4600
Mailing Address - Country:US
Mailing Address - Phone:615-683-3010
Mailing Address - Fax:615-683-3016
Practice Address - Street 1:8537 ASHEVILLE HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37924-4124
Practice Address - Country:US
Practice Address - Phone:865-225-7300
Practice Address - Fax:865-225-7301
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2498225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist