Healthcare Provider Details

I. General information

NPI: 1437119443
Provider Name (Legal Business Name): KATHARINE MARIE PIETZ M.ED., LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHARINE MARIE BUTLER

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 04/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 SW MARCIA DR
PULLMAN WA
99163-5253
US

IV. Provider business mailing address

PO BOX 641410
PULLMAN WA
99164-1410
US

V. Phone/Fax

Practice location:
  • Phone: 509-335-6230
  • Fax:
Mailing address:
  • Phone: 509-335-6230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: