Healthcare Provider Details

I. General information

NPI: 1356639231
Provider Name (Legal Business Name): KATELYN MCCORMICK HUTCHISON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATELYN HILL MCCORMICK PT

II. Dates (important events)

Enumeration Date: 07/13/2011
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375TH MEDICAL GROUP 310 WEST LOSEY STREET
SCOTT AFB IL
62225
US

IV. Provider business mailing address

375TH MEDICAL GROUP 310 WEST LOSEY STREET
SCOTT AFB IL
62225
US

V. Phone/Fax

Practice location:
  • Phone: 616-256-6280
  • Fax:
Mailing address:
  • Phone: 616-256-6280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2011020346
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: