Provider Demographics
NPI:1033681861
Name:PROPPE, KATHERINE (MHS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:PROPPE
Suffix:
Gender:F
Credentials:MHS, LAT, ATC
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:FULK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHS, LAT, ATC
Mailing Address - Street 1:434 LUNA BELLA LN APT 204
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-4506
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 AEROSPACE BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114
Practice Address - Country:US
Practice Address - Phone:386-323-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-35332255A2300X
FLAL57242255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer