MEDICARE: KATIE SKLUZACEK PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	8637	MN

General Provider Information

NPI Number	:	1144538588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE SKLUZACEK PT

Provider Business Mailing Address
First Line	:	1009 PRAIRIE CIR
Second Line	:
City	:	NORTHFIELD
State	:	MN
Zip	:	55057-3900
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1009 PRAIRIE CIR
Second Line	:
City	:	NORTHFIELD
State	:	MN
Zip	:	55057-3900
Country	:	US
Telephone Number	:	612-423-2481
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2010
Last Update Date	:	09/20/2010

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Directions to “ KATIE SKLUZACEK PT” Practice Location

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