Provider Demographics
NPI:1730922279
Name:FLETCHER, KATHY ANN (LMT)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:ANN
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3628 DERBY DOWNS DR
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-4600
Mailing Address - Country:US
Mailing Address - Phone:205-799-4255
Mailing Address - Fax:
Practice Address - Street 1:421 SKYLAND BLVD STE A-3
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-4020
Practice Address - Country:US
Practice Address - Phone:205-799-4255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4764225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist