Individual
KATHRYN K. NEWSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT, ATC
Contact information
Practice address
510 TIMBER DR E STE 102, GARNER, NC 27529-5285
(919) 500-5003
Mailing address
PO BOX 69030, BALTIMORE, MD 21264-9030
(757) 873-2302
(757) 873-2306
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
2305204678
VA
225100000X
Physical Therapist
Primary
P19170
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C05954
GROUP MEDICARE PTAN
VA
Enumeration date
08/25/2017
Last updated
10/03/2019
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