Provider Demographics
NPI:1275772709
Name:WASHINGTON, KAI D (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:KAI
Middle Name:D
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 SUNNYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-3337
Mailing Address - Country:US
Mailing Address - Phone:731-402-1375
Mailing Address - Fax:
Practice Address - Street 1:545 LANE AVE
Practice Address - Street 2:ATHLETIC DEPARTMENT
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301
Practice Address - Country:US
Practice Address - Phone:731-426-7668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAT00000012072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer