Provider Demographics
NPI:1598834913
Name:JEDLOVEC, KATHLEEN BRIDGET (BSPT MSTS PCS)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:BRIDGET
Last Name:JEDLOVEC
Suffix:
Gender:F
Credentials:BSPT MSTS PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15007 COLLIER DRIVE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35803-3689
Mailing Address - Country:US
Mailing Address - Phone:256-880-3263
Mailing Address - Fax:
Practice Address - Street 1:2075 MAX LUTHER DRIVE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35810-3859
Practice Address - Country:US
Practice Address - Phone:256-852-5600
Practice Address - Fax:256-852-6722
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH686225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
51511224OtherBLUE CROSS BLUE SHIELD