Provider Demographics
NPI:1790073641
Name:KESSLER, KRISTIE NICHOLE (PTA)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:NICHOLE
Last Name:KESSLER
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 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:
Practice Address - Street 1:102 HINES ROAD, NE
Practice Address - Street 2:STE. 3
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-9383
Practice Address - Country:US
Practice Address - Phone:706-602-9655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA002386225200000X
TNPTA4693225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant