Provider Demographics
NPI:1003559600
Name:DURRE, KATRINA KAY (PTA)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:KAY
Last Name:DURRE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 E LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:FLANAGAN
Mailing Address - State:IL
Mailing Address - Zip Code:61740-9030
Mailing Address - Country:US
Mailing Address - Phone:815-419-8153
Mailing Address - Fax:
Practice Address - Street 1:1402 LESLIE DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-5405
Practice Address - Country:US
Practice Address - Phone:309-603-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty