Provider Demographics
NPI:1356889992
Name:HINES, KONSTANCE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:KONSTANCE
Middle Name:
Last Name:HINES
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7827 ANNA CALLA WAY
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-5809
Mailing Address - Country:US
Mailing Address - Phone:901-246-6486
Mailing Address - Fax:
Practice Address - Street 1:7827 ANNA CALLA WAY
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-5809
Practice Address - Country:US
Practice Address - Phone:901-246-6486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN76132251P0200X
MSPT58572251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics