MEDICARE: KATIE ALEXANDRA RAISOR PT, 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	PTH9964	AL
2	225100000X	Physical Therapist	PT011670	GA

General Provider Information

NPI Number	:	1548669245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE ALEXANDRA RAISOR PT, DPT

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:	423-238-7217
Fax Number	:	423-238-3473

Provider Business Practice Location Address
First Line	:	6361 TALOKAS LN STE C170
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-5648
Country	:	US
Telephone Number	:	706-569-6250
Fax Number	:	706-569-6335

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

Provider Enumeration Date	:	08/19/2014
Last Update Date	:	08/24/2020

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