MEDICARE: MRS. KATRINA RENEE ISEMAN DPT

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	2251P0200X	Pediatric Physical Therapist	PT60828525	WA
2	2251P0200X	Pediatric Physical Therapist	199540	AK

General Provider Information

NPI Number	:	1609362664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATRINA RENEE ISEMAN DPT

Provider Business Mailing Address
First Line	:	11201 E GROW LN
Second Line	:
City	:	PALMER
State	:	AK
Zip	:	99645-8881
Country	:	US
Telephone Number	:	907-841-2525
Fax Number	:

Provider Business Practice Location Address
First Line	:	12812 OLD GLENN HWY STE A3
Second Line	:
City	:	EAGLE RIVER
State	:	AK
Zip	:	99577-7003
Country	:	US
Telephone Number	:	907-795-8115
Fax Number	:

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

Provider Enumeration Date	:	07/02/2018
Last Update Date	:	10/27/2023

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