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General NPI Number Information
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NPI Number | 1629574256
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Entity Type | Individual
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Provider Name | KATTHLEEN MIDDLETON PTA
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Gender | Female
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Dates
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Enumeration Date | 04/03/2018
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Last Update Date | 04/03/2018
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Provider Practice Location Address
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Address Line | 2041 HUBBARD RD
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City | MADISON
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State | OH
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Zip | 44057-2565
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Country | US
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Telephone | 440-428-2264
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Fax |
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Provider Business Mailing Address
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Address Line | 60 BETTY LOU DR
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City | MIDDLEFIELD
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State | OH
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Zip | 44062-9426
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Country | US
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Telephone | 440-812-3860
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 07219
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License Number State | OH
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