Provider Demographics
NPI:1104873363
Name:STOGNER, KITTY JOSETTE (PT, ATP)
Entity type:Individual
Prefix:MRS
First Name:KITTY
Middle Name:JOSETTE
Last Name:STOGNER
Suffix:
Gender:F
Credentials:PT, ATP
Other - Prefix:
Other - First Name:JODIE
Other - Middle Name:
Other - Last Name:STOGNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:521 PELAHATCHIE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-6282
Mailing Address - Country:US
Mailing Address - Phone:601-613-7328
Mailing Address - Fax:
Practice Address - Street 1:521 PELAHATCHIE SHORE DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047-6282
Practice Address - Country:US
Practice Address - Phone:601-613-7328
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3204225100000X
ALPTH4728225100000X
TNPT7497225100000X
LATP#06987R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08056277Medicaid
MSP00290845Medicare ID - Type UnspecifiedMEDICARE RAILROAD
MS08056277Medicaid