Provider Demographics
NPI:1114138567
Name:HETHERINGTON, KARIN KAY (PT)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:KAY
Last Name:HETHERINGTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KARIN
Other - Middle Name:K
Other - Last Name:CARLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3300 ALLEGHENY DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-4448
Mailing Address - Country:US
Mailing Address - Phone:770-565-5863
Mailing Address - Fax:
Practice Address - Street 1:2155 POST OAK TRITT RD
Practice Address - Street 2:SUITE 400
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-8620
Practice Address - Country:US
Practice Address - Phone:770-565-4044
Practice Address - Fax:770-565-5653
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT003583225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist