Provider Demographics
NPI:1679857619
Name:KINNISON, KATHY LYNN (PT)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:LYNN
Last Name:KINNISON
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 1:203 AVALON AVE
Mailing Address - Street 2:SUITE 340
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35661-2869
Mailing Address - Country:US
Mailing Address - Phone:256-386-2649
Mailing Address - Fax:256-386-1143
Practice Address - Street 1:203 AVALON AVE
Practice Address - Street 2:SUITE 340
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661-2869
Practice Address - Country:US
Practice Address - Phone:256-386-2649
Practice Address - Fax:256-386-1143
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH6903225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist