Healthcare Provider Details

I. General information

NPI: 1538448477
Provider Name (Legal Business Name): KATIE VASKO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATIE L MAPES PT

II. Dates (important events)

Enumeration Date: 08/10/2011
Last Update Date: 05/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 PAGE AVE
JACKSON MI
49201-2418
US

IV. Provider business mailing address

206 PAGE AVE
JACKSON MI
49201-2418
US

V. Phone/Fax

Practice location:
  • Phone: 517-783-6670
  • Fax: 517-783-5310
Mailing address:
  • Phone: 517-783-6670
  • Fax: 517-783-5310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501015664
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: