Healthcare Provider Details

I. General information

NPI: 1952810996
Provider Name (Legal Business Name): KATO PHYSICAL MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2017
Last Update Date: 09/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SOUTH FRONT STREET
MANKATO MN
56001
US

IV. Provider business mailing address

100 THOMAS DRIVE APT 209
MANKATO MN
56001
US

V. Phone/Fax

Practice location:
  • Phone: 507-594-9100
  • Fax:
Mailing address:
  • Phone: 314-398-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State

VIII. Authorized Official

Name: TJODE MAURETTE MICKELSON
Title or Position: OWNER
Credential:
Phone: 314-398-5800