Provider Demographics
NPI:1316399454
Name:THOMAS, KATIE DIANNE (DPT)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:DIANNE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 NEWNAN ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3335
Mailing Address - Country:US
Mailing Address - Phone:678-664-1224
Mailing Address - Fax:
Practice Address - Street 1:505 NEWNAN ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3335
Practice Address - Country:US
Practice Address - Phone:678-664-1224
Practice Address - Fax:669-600-6904
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12401225100000X
GAPT012401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist