Healthcare Provider Details

I. General information

NPI: 1053220582
Provider Name (Legal Business Name): KATIE THOMSEN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 JOE KENNEDY BLVD
STATESBORO GA
30458-3417
US

IV. Provider business mailing address

32 JOE KENNEDY BLVD
STATESBORO GA
30458-3417
US

V. Phone/Fax

Practice location:
  • Phone: 912-344-9657
  • Fax: 912-259-9668
Mailing address:
  • Phone: 912-344-9657
  • Fax: 912-259-9668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT018607
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: