Healthcare Provider Details

I. General information

NPI: 1720648470
Provider Name (Legal Business Name): KATHLEEN GRACE ANDREW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN GLEASON

II. Dates (important events)

Enumeration Date: 06/15/2019
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2812 OLD FORT PKWY STE D
MURFREESBORO TN
37128-4265
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 615-603-7374
  • Fax:
Mailing address:
  • Phone: 423-238-7217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number17265
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305212833
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: