Provider Demographics
NPI:1275953721
Name:NEWSOM, KATHRYN CORINNE (PT, DPT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:CORINNE
Last Name:NEWSOM
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 ATRIUM WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-6301
Mailing Address - Country:US
Mailing Address - Phone:038-771-0370
Mailing Address - Fax:803-771-0371
Practice Address - Street 1:1718 SAINT JULIAN PL
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2410
Practice Address - Country:US
Practice Address - Phone:038-771-0370
Practice Address - Fax:803-771-0371
Is Sole Proprietor?:No
Enumeration Date:2014-04-23
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0012005225100000X
SC6899225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000142370Medicaid
CO9000142370Medicaid