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General NPI Number Information
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NPI Number | 1972330199
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Entity Type | Individual
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Provider Name | KATELYNN DUTCHER ATC, LAT
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Gender | Female
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Dates
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Enumeration Date | 09/19/2024
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Last Update Date | 09/19/2024
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Provider Practice Location Address
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Address Line | 555 SE UNIVERSITY AVE
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City | WAUKEE
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State | IA
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Zip | 50263-8171
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Country | US
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Telephone | 515-987-5163
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Fax |
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Provider Business Mailing Address
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Address Line | 17138 BLUE SAGE LN
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City | URBANDALE
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State | IA
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Zip | 50323-2791
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Country | US
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Telephone |
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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 | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 079645
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License Number State | IA
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