Healthcare Provider Details

I. General information

NPI: 1942616701
Provider Name (Legal Business Name): CHERYL ANN KOTHE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHERYL ANN PAEPLOW

II. Dates (important events)

Enumeration Date: 07/01/2014
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 RAILROAD ST
SWEETWATER TN
37874-3013
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
BIRMINGHAM AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 423-337-7897
  • Fax: 423-337-7943
Mailing address:
  • Phone: 423-238-8930
  • Fax: 423-954-7408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10048
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10048
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: