Provider Demographics
NPI:1386018448
Name:DEBERRY, KATHRYN E (DPT)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:E
Last Name:DEBERRY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:KATHRYN
Other - Middle Name:E
Other - Last Name:ADCOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:309 SWEETLAND DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-6431
Mailing Address - Country:US
Mailing Address - Phone:210-367-6260
Mailing Address - Fax:423-238-1277
Practice Address - Street 1:15331 RANKIN AVE
Practice Address - Street 2:
Practice Address - City:DUNLAP
Practice Address - State:TN
Practice Address - Zip Code:37327-7048
Practice Address - Country:US
Practice Address - Phone:423-949-7246
Practice Address - Fax:423-949-7247
Is Sole Proprietor?:No
Enumeration Date:2015-11-30
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10568225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist