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NPI Code Detail

MEDICARE: KATHRYN K. NEWSOM PT, DPT, ATC

MEDICARE: KATHRYN K. NEWSOM PT, DPT, ATC
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
1225100000XPhysical Therapist2305204678VA
2225100000XPhysical TherapistP19170NC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1C05954OTHERVAGROUP MEDICARE PTAN

General Provider Information

NPI Number : 1750808283
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHRYN K. NEWSOM PT, DPT, ATC
Provider Business Mailing Address
First Line : PO BOX 69030
Second Line :
City : BALTIMORE
State : MD
Zip : 21264-9030
Country : US
Telephone Number : 757-873-2302
Fax Number : 757-873-2306
Provider Business Practice Location Address
First Line : 510 TIMBER DR E STE 102
Second Line :
City : GARNER
State : NC
Zip : 27529-5285
Country : US
Telephone Number : 919-500-5003
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2017
Last Update Date : 10/03/2019

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