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General NPI Number Information
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NPI Number | 1033902309
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Entity Type | Individual
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Provider Name | KATHRYN MAE CHOUINARD
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Gender | Female
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Dates
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Enumeration Date | 05/28/2025
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 470 MALL BLVD STE D
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City | DYERSBURG
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State | TN
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Zip | 38024-1648
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Country | US
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Telephone | 731-259-9995
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Fax |
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Provider Business Mailing Address
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Address Line | 251 RIDGE RD
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City | MEDINA
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State | TN
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Zip | 38355-7611
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Country | US
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Telephone | 731-426-5554
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 16435
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License Number State | TN
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