Provider Demographics
NPI:1417467317
Name:KAUTZMAN, EMILY (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:KAUTZMAN
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 RIVER HEIGHTS DR APT 203
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-6976
Mailing Address - Country:US
Mailing Address - Phone:406-740-0183
Mailing Address - Fax:
Practice Address - Street 1:76 S HOUSTON LEVEE RD
Practice Address - Street 2:
Practice Address - City:EADS
Practice Address - State:TN
Practice Address - Zip Code:38028-7024
Practice Address - Country:US
Practice Address - Phone:901-765-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-05
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X, 2255A2300X
TN23662255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty