Provider Demographics
NPI:1922444207
Name:GARRARD, KELLY POWE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:POWE
Last Name:GARRARD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:POWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
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 1:105 N MAIN ST
Practice Address - Street 2:STE C
Practice Address - City:CLEVELAND
Practice Address - State:GA
Practice Address - Zip Code:30528-1123
Practice Address - Country:US
Practice Address - Phone:706-219-4507
Practice Address - Fax:706-865-1501
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010280225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist