Healthcare Provider Details

I. General information

NPI: 1669086864
Provider Name (Legal Business Name): KATHERINE VACHON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHERINE MILLER

II. Dates (important events)

Enumeration Date: 09/04/2020
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 W STONES CROSSING RD STE 120
GREENWOOD IN
46143-8558
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1076
US

V. Phone/Fax

Practice location:
  • Phone: 317-528-2018
  • Fax: 317-528-2907
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05013819A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: