Provider Demographics
NPI:1306012471
Name:HEALY, KATHERINE EMILY-FRANCES (LMT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:EMILY-FRANCES
Last Name:HEALY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 CANNON CRSE SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-2843
Mailing Address - Country:US
Mailing Address - Phone:770-726-9097
Mailing Address - Fax:
Practice Address - Street 1:129 MIRRAMONT LAKE DR
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-8215
Practice Address - Country:US
Practice Address - Phone:404-725-1274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT004611172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist