Healthcare Provider Details

I. General information

NPI: 1720872286
Provider Name (Legal Business Name): KATHERINE VANDIFORD PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHERINE SICKINGER PT, DPT

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 AMSTERDAM AVE
NEW YORK NY
10023-3902
US

IV. Provider business mailing address

333 W 57TH ST APT 214
NEW YORK NY
10019-3116
US

V. Phone/Fax

Practice location:
  • Phone: 646-795-3850
  • Fax:
Mailing address:
  • Phone: 937-267-6591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number049424
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: