1518324367 NPI number — KATHERINE SARAH KAHLER DPT, ATC

Table of content: KATHERINE SARAH KAHLER DPT, ATC (NPI 1518324367)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518324367 NPI number — KATHERINE SARAH KAHLER DPT, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAHLER
Provider First Name:
KATHERINE
Provider Middle Name:
SARAH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT, ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NIEBUHR
Provider Other First Name:
KATIE
Provider Other Middle Name:
S
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT, ATC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1518324367
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2758
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERLOO
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50704-2758
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-235-5390
Provider Business Mailing Address Fax Number:
319-235-5607

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2351 HUDSON RD
Provider Second Line Business Practice Location Address:
SUITE 164
Provider Business Practice Location Address City Name:
CEDAR FALLS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50614-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-273-5265
Provider Business Practice Location Address Fax Number:
319-273-5266
Provider Enumeration Date:
01/25/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  004712 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1518324367 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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