Healthcare Provider Details

I. General information

NPI: 1497573596
Provider Name (Legal Business Name): KATHLYN D NORMAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 09/30/2024
Certification Date: 09/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1426 WOOD NYMPH TRL
LOOKOUT MOUNTAIN GA
30750-2630
US

IV. Provider business mailing address

1426 WOOD NYMPH TRL
LOOKOUT MOUNTAIN GA
30750-2630
US

V. Phone/Fax

Practice location:
  • Phone: 205-471-4675
  • Fax:
Mailing address:
  • Phone: 205-471-4675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT015873
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: