Provider Demographics
NPI:1184763070
Name:PRIEST, KAREN DAWN (PTA)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:DAWN
Last Name:PRIEST
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 1:401 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:OBION
Mailing Address - State:TN
Mailing Address - Zip Code:38240-5807
Mailing Address - Country:US
Mailing Address - Phone:731-536-0634
Mailing Address - Fax:
Practice Address - Street 1:620 MALL BLVD
Practice Address - Street 2:SUITE B1
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-1649
Practice Address - Country:US
Practice Address - Phone:731-285-5552
Practice Address - Fax:731-285-5350
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA0000002231225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant