Provider Demographics
NPI:1053511196
Name:SCHWARTZKOPF-PHIFER, KATHRYN B (PT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:B
Last Name:SCHWARTZKOPF-PHIFER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:B
Other - Last Name:SCHWARTZKOPF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42302-0127
Mailing Address - Country:US
Mailing Address - Phone:603-427-8066
Mailing Address - Fax:603-501-0495
Practice Address - Street 1:412 E 2ND ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-4204
Practice Address - Country:US
Practice Address - Phone:270-926-8145
Practice Address - Fax:270-926-8147
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05009303A225100000X
KY005603225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000577030OtherBLUE CROSS BLUE SHIELD
IN000000631982OtherBLUE CROSS BLUE SHIELD
IN200893740Medicaid
IN000000631982OtherBLUE CROSS BLUE SHIELD
IN200893740Medicaid
IN216070YMedicare PIN