Provider Demographics
NPI:1841363843
Name:MCCOLUMN, KATHY R (PT)
Entity type:Individual
Prefix:MS
First Name:KATHY
Middle Name:R
Last Name:MCCOLUMN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5225 HIGHWAY 18 W
Mailing Address - Street 2:SUITE C
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39209-9420
Mailing Address - Country:US
Mailing Address - Phone:601-487-8456
Mailing Address - Fax:601-487-8664
Practice Address - Street 1:5225 HIGHWAY 18 W
Practice Address - Street 2:SUITE C
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39209-9420
Practice Address - Country:US
Practice Address - Phone:601-487-8456
Practice Address - Fax:601-487-8664
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT 0908225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05453592Medicaid
MS302I654571Medicare UPIN
MS05453592Medicaid