Provider Demographics
NPI:1043706310
Name:SEALE, KATHERINE BUTLER (DPT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:BUTLER
Last Name:SEALE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:PAIGE
Other - Last Name:SEALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:129 N FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2319
Mailing Address - Country:US
Mailing Address - Phone:865-809-4936
Mailing Address - Fax:
Practice Address - Street 1:1140 PERIMETER PARK DR
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-0922
Practice Address - Country:US
Practice Address - Phone:931-526-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
TN14514225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN14514OtherPHYSICAL THERAPY LICENSE
GAPT013483OtherLICENSE