Provider Demographics
NPI:1447796198
Name:KIZZIRE, KARI E (DPT)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:E
Last Name:KIZZIRE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KARI
Other - Middle Name:E
Other - Last Name:HODGDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 949
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162-0949
Mailing Address - Country:US
Mailing Address - Phone:912-638-1444
Mailing Address - Fax:912-638-0077
Practice Address - Street 1:212 RETREAT VLG
Practice Address - Street 2:
Practice Address - City:ST SIMONS IS
Practice Address - State:GA
Practice Address - Zip Code:31522-2403
Practice Address - Country:US
Practice Address - Phone:912-638-1444
Practice Address - Fax:912-638-0077
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT012087225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT012087OtherPT LICENSE