MEDICARE: KATHLEEN ROSE PT

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	7090	TN

General Provider Information

NPI Number	:	1871826685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN ROSE PT

Provider Business Mailing Address
First Line	:	550 BURNETT RD
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-6201
Country	:	US
Telephone Number	:	615-533-6659
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 BURNETT RD
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-6201
Country	:	US
Telephone Number	:	615-533-6659
Fax Number	:

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

Provider Enumeration Date	:	09/11/2009
Last Update Date	:	09/11/2009

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Directions to “ KATHLEEN ROSE PT” Practice Location

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