Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT011627 | GA |
NPI | 1003323072 |
---|---|
Provider Name | Kathryn Hodges Rose |
First Address | Chattanooga, TN 37421-2564 |
Second Address | Roswell, GA 30076-3866 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2017 |
Last Update Date | 29/12/2017 |