Healthcare Provider Details

I. General information

NPI: 1154877959
Provider Name (Legal Business Name): KATELYN SOUTHWICK DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SAINT PATRICKS DR SUITE 401
WALDORF MD
20603-4527
US

IV. Provider business mailing address

20754 W DIXIE HWY
MIAMI FL
33180-1146
US

V. Phone/Fax

Practice location:
  • Phone: 301-870-7366
  • Fax:
Mailing address:
  • Phone: 305-935-9599
  • Fax: 305-932-5612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: