Provider Demographics
NPI:1194335778
Name:DEVICK, KATHERINE ELISE (DPT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ELISE
Last Name:DEVICK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 999
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31776-0999
Mailing Address - Country:US
Mailing Address - Phone:229-985-2080
Mailing Address - Fax:229-890-3397
Practice Address - Street 1:2410 W PLAZA DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5325
Practice Address - Country:US
Practice Address - Phone:850-385-6185
Practice Address - Fax:850-385-2580
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT015331225100000X
FLPT36094225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist