Provider Demographics
NPI:1457480840
Name:DEAN, KATHERINE M (PT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:DEAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 407
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31702-0407
Mailing Address - Country:US
Mailing Address - Phone:229-883-4707
Mailing Address - Fax:229-883-1189
Practice Address - Street 1:2002 PALMYRA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1591
Practice Address - Country:US
Practice Address - Phone:229-883-8914
Practice Address - Fax:229-888-0565
Is Sole Proprietor?:No
Enumeration Date:2007-03-03
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT009010225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist