Healthcare Provider Details

I. General information

NPI: 1700488095
Provider Name (Legal Business Name): KARI CHRISTINE WILLETT PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2020
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 DURAN DR
SHELBYVILLE IN
46176-1986
US

IV. Provider business mailing address

302 DURAN DR
SHELBYVILLE IN
46176-1986
US

V. Phone/Fax

Practice location:
  • Phone: 812-519-2004
  • Fax: 812-519-1708
Mailing address:
  • Phone: 812-519-2004
  • Fax: 812-519-1708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT014712
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05013981A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: