=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780074955
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KAT'S PT, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2015
-----------------------------------------------------
Last Update Date | 01/27/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 848 N RAINBOW BLVD #A60
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89107-1103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-219-1660
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 848 N RAINBOW BLVD #A60
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89107-1103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-219-1660
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST
-----------------------------------------------------
Name | KATHERINE GRACE BERNARDO
-----------------------------------------------------
Credential | P.T.
-----------------------------------------------------
Telephone | 702-219-1660
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251P0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Physical Therapist
-----------------------------------------------------
License Number | 1524
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------