Individual
KATHERINE SUSANNA MEDLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
9222 LEE HWY STE C, OOLTEWAH, TN 37363-8872
(423) 238-9444
(423) 238-9499
Mailing address
8823 PRODUCTION LN, OOLTEWAH, TN 37363-6511
(423) 238-7217
(423) 238-3473
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0446652
—
TN
01
—
3156797
BCBST- GROUP NUMBER
TN
05
—
3645813
—
TN
01
—
4109673
BCBST
TN
Enumeration date
06/02/2006
Last updated
11/05/2012
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