Provider Demographics
NPI:1841238193
Name:MEDLEY, KATHERINE SUSANNA (DPT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:SUSANNA
Last Name:MEDLEY
Suffix:
Gender:F
Credentials:DPT
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:423-238-3473
Practice Address - Street 1:9222 LEE HWY STE C
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-8872
Practice Address - Country:US
Practice Address - Phone:423-238-9444
Practice Address - Fax:423-238-9499
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0446652Medicaid
TN3156797OtherBCBST- GROUP NUMBER
TN3645813Medicaid
TN4109673OtherBCBST
TN0446652Medicaid
TN4109673OtherBCBST