MEDICARE: KATHRYN JEAN KOEHN M.P.T.

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	0540	SD

General Provider Information

NPI Number	:	1164570743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN JEAN KOEHN M.P.T.

Provider Business Mailing Address
First Line	:	615 LAKOTA CT
Second Line	:
City	:	BRANDON
State	:	SD
Zip	:	57005-1934
Country	:	US
Telephone Number	:	605-582-3385
Fax Number	:	605-582-8734

Provider Business Practice Location Address
First Line	:	1721 S CLEVELAND AVE
Second Line	:	SUITE 200
City	:	SIOUX FALLS
State	:	SD
Zip	:	57103-5501
Country	:	US
Telephone Number	:	605-582-8718
Fax Number	:	605-582-8734

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/08/2007

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