MEDICARE: KELLY CATHERYN IRELAND DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	P24681	NC
2	225100000X	Physical Therapist	17048	TN

General Provider Information

NPI Number	:	1427909977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY CATHERYN IRELAND DPT

Provider Business Mailing Address
First Line	:	106 INDUSTRIAL PARK DR
Second Line	:
City	:	SODDY DAISY
State	:	TN
Zip	:	37379-4224
Country	:	US
Telephone Number	:	423-815-2722
Fax Number	:	423-815-2722

Provider Business Practice Location Address
First Line	:	106 INDUSTRIAL PARK DR
Second Line	:
City	:	SODDY DAISY
State	:	TN
Zip	:	37379-4224
Country	:	US
Telephone Number	:	423-815-2722
Fax Number	:	423-815-2722

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/10/2026

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