Provider Demographics
NPI:1386017788
Name:LIGHT, KATHYE (PT)
Entity Type:Individual
Prefix:
First Name:KATHYE
Middle Name:
Last Name:LIGHT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:DR
Other - First Name:KATHYE
Other - Middle Name:
Other - Last Name:LIGHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:6557 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:GA
Mailing Address - Zip Code:30527-1351
Mailing Address - Country:US
Mailing Address - Phone:352-359-8311
Mailing Address - Fax:
Practice Address - Street 1:500 WASHINGTON ST. SE
Practice Address - Street 2:BRENAU UNIVERSITY PHYSICAL THERAPY DEPARTMENT
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501
Practice Address - Country:US
Practice Address - Phone:352-359-8311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011504225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist