Basic Information
| Provider Information | |||||||||
| NPI: | 1750767596 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | KOETTERS | ||||||||
| FirstName: | KATHRYN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31186 W 166TH ST | ||||||||
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| City: | GARDNER | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660307841 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 10000 W 75TH ST STE 250 | ||||||||
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| City: | MERRIAM | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662042218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9138941910 | ||||||||
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| ProviderEnumerationDate: | 08/04/2015 | ||||||||
| LastUpdateDate: | 08/04/2015 | ||||||||
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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 | 225200000X | 14-01298 | KS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | 225200000X | 2015026054 | MO | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.