Individual
DIERDRE LOUISE CHARLETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
187 GALLAHER RD, KINGSTON, TN 37763-4721
(865) 376-4620
Mailing address
PO BOX 4847, OAK RIDGE, TN 37831-4847
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
12758
TN
Other
Enumeration date
03/23/2020
Last updated
03/23/2020
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