Provider Demographics
NPI:1457007262
Name:FREEMAN, KENNETH (DPT)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 WILCOX BLVD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-3023
Mailing Address - Country:US
Mailing Address - Phone:423-498-6546
Mailing Address - Fax:423-498-6509
Practice Address - Street 1:3300 WILCOX BLVD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-3023
Practice Address - Country:US
Practice Address - Phone:423-498-6546
Practice Address - Fax:423-498-6509
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13912225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist