Provider Demographics
NPI:1982132437
Name:STOUTENBOROUGH, ELIZABETH KATHRYN (PT, DPT, ATC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KATHRYN
Last Name:STOUTENBOROUGH
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:KATHRYN
Other - Last Name:CHAPPELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, ATC
Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2564
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:17134 BEL RAY PL
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012
Practice Address - Country:US
Practice Address - Phone:816-318-0434
Practice Address - Fax:816-318-0437
Is Sole Proprietor?:No
Enumeration Date:2017-05-29
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT32669225100000X
KS11-05975225100000X
MO2018014343225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist