Individual
MRS. KATHLEEN ANN ILLIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
6655 QUINCE RD STE 101, MEMPHIS, TN 38119-8031
(901) 755-9988
(901) 755-2233
Mailing address
6655 QUINCE RD STE 101, MEMPHIS, TN 38119-8031
(901) 755-9988
(901) 755-2233
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA 0000003466
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3077388
BCBS PROVIDER NUMBER
TN
Enumeration date
11/29/2006
Last updated
07/08/2007
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