Provider Demographics
NPI:1780825588
Name:DELK, KARA A (PTA)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:A
Last Name:DELK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:A
Other - Last Name:BRADSHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:683 BASKINS ROAD
Mailing Address - Street 2:
Mailing Address - City:BURLISON
Mailing Address - State:TN
Mailing Address - Zip Code:38015
Mailing Address - Country:US
Mailing Address - Phone:901-476-8839
Mailing Address - Fax:
Practice Address - Street 1:121 PHYSICIANS DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305
Practice Address - Country:US
Practice Address - Phone:731-664-5050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN321225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant