=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124418967
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. KATHRINE DUNLAP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2015
-----------------------------------------------------
Last Update Date | 02/02/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 897 EVERGREEN ST
-----------------------------------------------------
City | DRESDEN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38225-2305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-514-3841
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 897 EVERGREEN ST
-----------------------------------------------------
City | DRESDEN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38225-2305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-514-3841
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | 5281
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------