Provider Demographics
NPI:1891853040
Name:SHEESLEY, KATHY JEAN B (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:KATHY JEAN
Middle Name:B
Last Name:SHEESLEY
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1754 ALDERBROOK RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-4110
Mailing Address - Country:US
Mailing Address - Phone:404-520-8249
Mailing Address - Fax:
Practice Address - Street 1:5839 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3486
Practice Address - Country:US
Practice Address - Phone:404-520-8249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2015-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT000727225100000X
FLPT30779225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist