Kathleen L Slade, PTA
Individual provider Active NPI Physical Therapy Assistant · Jackson, WY
NPI 1720151285 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1720151285
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- PTA-465 (WY)
- Practice address
- 1090 S Highway 89
Jackson, WY 83001 - Phone
- (307) 733-5577
- Fax
- (307) 733-5505
- NPI assigned
- Nov 15, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA-465 | WY | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Four Pines Physical Therapy PC | Past |
Accepting new patients | |
| Four Pines Physical Therapy Limited Partnership | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA-465 | WY | Yes |
Addresses
Primary practice location
1090 S Highway 89
Jackson, WY 83001
Mailing address
PO Box 8467
Jackson, WY 83002-8467
Phone (307) 733-5577
Other providers in Jackson, WY
- Tara Singh
- Rebecca Ashley Sjostrom
- Robert M Skaggs
- Geoffrey K Skene
- Sky Physical Therapy Inc.
- Emily Sloan
- Smiles 4 Kids Jackson LLC
- Lewis A Smirl
- Barbara E Smith
- Cary G. Smith
All providers in Jackson, WY · Physical Therapy Assistant in Wyoming
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.