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NPI Code Detail

MEDICARE: MRS. KATRINA LORAE KOLTZ PT, DPT

MEDICARE: MRS. KATRINA LORAE KOLTZ PT, DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist070021526IL

General Provider Information

NPI Number : 1235505488
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KATRINA LORAE KOLTZ PT, DPT
Provider Business Mailing Address
First Line : 18215 HARLEM AVE
Second Line :
City : TINLEY PARK
State : IL
Zip : 60477-3609
Country : US
Telephone Number : 708-444-2563
Fax Number : 708-444-2769
Provider Business Practice Location Address
First Line : 18215 HARLEM AVE
Second Line :
City : TINLEY PARK
State : IL
Zip : 60477-3609
Country : US
Telephone Number : 708-444-2563
Fax Number : 708-444-2769
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2015
Last Update Date : 08/11/2015

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