Basic Information
| Provider Information | |||||||||
| NPI: | 1639403777 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PETTIGREW-WEEMS | ||||||||
| FirstName: | KATIE | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MPT | ||||||||
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| OtherLastName: | PETTIGREW | ||||||||
| OtherFirstName: | KATIE | ||||||||
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| OtherCredential: | MPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 600 CENTRAL AVE SE | ||||||||
| Address2: | SUITE D | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871023656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052422294 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6330 RIVERSIDE PLAZA LN NW | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871202681 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5053127930 | ||||||||
| FaxNumber: | 5057172818 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2009 | ||||||||
| LastUpdateDate: | 02/28/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 3760 | NM | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.