Healthcare Provider Details

I. General information

NPI: 1215806591
Provider Name (Legal Business Name): KALIE E ERTWINE DPT, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2025
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LINDSEY LN STE A
SAINT MARYS GA
31558-1727
US

IV. Provider business mailing address

5830 GRANITE PKWY STE 800
PLANO TX
75024-6775
US

V. Phone/Fax

Practice location:
  • Phone: 912-729-1333
  • Fax: 912-729-5259
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP061514T
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT031216
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: