Healthcare Provider Details

I. General information

NPI: 1225429541
Provider Name (Legal Business Name): KATHERINE BEGEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE HALLADA PT,MSPT, ATC

II. Dates (important events)

Enumeration Date: 02/09/2015
Last Update Date: 09/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7057 DEXTER ANN ARBOR RD
DEXTER MI
48130-8568
US

IV. Provider business mailing address

790 REMINGTON BLVD
BOLINGBROOK IL
60440-4909
US

V. Phone/Fax

Practice location:
  • Phone: 734-426-1406
  • Fax: 734-426-1406
Mailing address:
  • Phone: 630-296-2223
  • Fax: 630-759-9510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501002993
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: