Provider Demographics
NPI:1053030387
Name:ESTRIDGE, KATHRYN ANNE (PT)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:ANNE
Last Name:ESTRIDGE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:ESTRIDGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:4501 MONTIBELLO DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-7422
Mailing Address - Country:US
Mailing Address - Phone:704-840-5444
Mailing Address - Fax:
Practice Address - Street 1:4501 MONTIBELLO DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-7422
Practice Address - Country:US
Practice Address - Phone:704-840-5444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9957225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist