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Organization
SOUTHERN REHAB & AQUATICS
Active
Organization
SOUTHERN REHAB & AQUATICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TRACE DEWAYNE KENNEMORE PT (PT)
(423) 837-7536
Entity
Organization
Contact information
Practice address
400 DIXIE LEE CENTER RD, SUITE A, KIMBALL, TN 37347-5672
(423) 837-7536
(423) 837-7538
Mailing address
400 DIXIE LEE CENTER RD, KIMBALL, TN 37347-5672
(423) 837-7536
(423) 837-7538
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT0000006009
TN
Other
Enumeration date
03/29/2007
Last updated
04/28/2008
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