Provider Demographics
NPI:1104910124
Name:PATRICK, KATHRYN CLARKIN (PT)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:CLARKIN
Last Name:PATRICK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 VANDERBILT RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2807
Mailing Address - Country:US
Mailing Address - Phone:828-274-2755
Mailing Address - Fax:
Practice Address - Street 1:COUNTRY CLUB ROAD
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712
Practice Address - Country:US
Practice Address - Phone:828-877-3877
Practice Address - Fax:828-877-5160
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1421225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC079VUOtherBLUE CROSS BLUE SHIELD NC
NC079VUOtherBLUE CROSS BLUE SHIELD NC