Provider Demographics
NPI:1700488095
Name:WILLETT, KARI CHRISTINE (PT)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:CHRISTINE
Last Name:WILLETT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 DURAN DR
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-1986
Mailing Address - Country:US
Mailing Address - Phone:812-519-2004
Mailing Address - Fax:812-519-1708
Practice Address - Street 1:302 DURAN DR
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-1986
Practice Address - Country:US
Practice Address - Phone:812-519-2004
Practice Address - Fax:812-519-1708
Is Sole Proprietor?:No
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT014712225100000X
IN05013981A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist