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General NPI Number Information
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NPI Number | 1952810996
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Entity Type | Organization
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Legal Business Name | KATO PHYSICAL MEDICINE, LLC
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Dates
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Enumeration Date | 09/21/2017
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Last Update Date | 09/21/2017
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Provider Practice Location Address
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Address Line | 800 SOUTH FRONT STREET
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City | MANKATO
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State | MN
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Zip | 56001
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Country | US
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Telephone | 507-594-9100
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Fax |
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Provider Business Mailing Address
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Address Line | 100 THOMAS DRIVE APT 209
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City | MANKATO
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State | MN
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Zip | 56001
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Country | US
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Telephone | 314-398-5800
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TJODE MAURETTE MICKELSON
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Credential |
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Telephone | 314-398-5800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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