Provider Demographics
NPI:1083140859
Name:DOUGLAS, KATLYN JO (PT, DPT, ATC)
Entity Type:Individual
Prefix:
First Name:KATLYN
Middle Name:JO
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2564
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:501 S MADISON ST
Practice Address - Street 2:STE L
Practice Address - City:WEBB CITY
Practice Address - State:MO
Practice Address - Zip Code:64870-2502
Practice Address - Country:US
Practice Address - Phone:417-673-2156
Practice Address - Fax:417-673-2176
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-05675225100000X
ARPT4604225100000X
MO2017022200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist