Provider Demographics
NPI:1568990018
Name:HAYES, KATHERINE ANN (PTA)
Entity Type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:ANN
Last Name:HAYES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1387 41 N BLUE RIDGE NURSING HOME CALHOUN
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-4701
Mailing Address - Country:US
Mailing Address - Phone:706-629-1289
Mailing Address - Fax:
Practice Address - Street 1:BLUE RIDGE NURSING HOME CALHOUN
Practice Address - Street 2:1387 US 41 N
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701
Practice Address - Country:US
Practice Address - Phone:706-629-1289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-30
Last Update Date:2017-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA001751225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty