=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457465049
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VIMLA B KATARA MADISON PHYSICAL THERAPY CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2006
-----------------------------------------------------
Last Update Date | 06/17/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18506 NW MONTREUX DR
-----------------------------------------------------
City | ISSAQUAH
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98027-7871
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-401-8182
-----------------------------------------------------
Fax | 425-401-8182
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18506 NW MONTREUX DR
-----------------------------------------------------
City | ISSAQUAH
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98027-7871
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-401-8182
-----------------------------------------------------
Fax | 425-401-8182
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE PROPRIETOR/OWNER
-----------------------------------------------------
Name | MS. VIMLA B KATARA
-----------------------------------------------------
Credential | P.T.
-----------------------------------------------------
Telephone | 425-401-8182
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT00001092
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------