Dierdre Louise Charlett
Physical Therapist, Pediatrics in Kingston, TN. Individual provider (NPI-1).
NPI number1164059093
StatusActive
Last updated in NPPESMar 23, 2020
Details
- NPI
- 1164059093
- Entity type
- Individual (NPI-1)
- Name
- Dierdre Louise Charlett
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Mar 23, 2020
- Certification date
- Mar 23, 2020
- Last updated
- Mar 23, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2251P0200X | Physical Therapist, Pediatrics | 12758 | TN | Yes |
Practice location
187 Gallaher RdKingston, TN 37763-4721
Phone 865-376-4620
Mailing address
Po Box 4847Oak Ridge, TN 37831-4847
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