MEDICARE: KATHRYN CORINNE NEWSOM PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PTL.0012005	CO
2	225100000X	Physical Therapist	6899	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275953721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN CORINNE NEWSOM PT, DPT

Provider Business Mailing Address
First Line	:	141 ATRIUM WAY
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-6301
Country	:	US
Telephone Number	:	38-771-0370
Fax Number	:	803-771-0371

Provider Business Practice Location Address
First Line	:	1718 SAINT JULIAN PL
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2410
Country	:	US
Telephone Number	:	38-771-0370
Fax Number	:	803-771-0371

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2014
Last Update Date	:	10/04/2021

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