Provider Demographics
NPI:1477118438
Name:PLUMMER, KIT ADAM (PTA, LMT)
Entity Type:Individual
Prefix:
First Name:KIT
Middle Name:ADAM
Last Name:PLUMMER
Suffix:
Gender:M
Credentials:PTA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 STEAM PLANT RD
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-3027
Mailing Address - Country:US
Mailing Address - Phone:615-230-4600
Mailing Address - Fax:
Practice Address - Street 1:419 STEAM PLANT RD
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-3027
Practice Address - Country:US
Practice Address - Phone:615-230-7614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010001558225700000X
MO2018037381225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT981305392OtherDRIVERS LICENSE