Provider Demographics
NPI:1063461978
Name:EWALT, KATHERINE LOUISE (MS, ATC, HHP, NCTM)
Entity Type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:LOUISE
Last Name:EWALT
Suffix:
Gender:F
Credentials:MS, ATC, HHP, NCTM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 TRUXTUN RD
Mailing Address - Street 2:SUITE #206
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-6172
Mailing Address - Country:US
Mailing Address - Phone:619-225-5762
Mailing Address - Fax:
Practice Address - Street 1:2650 TRUXTUN RD
Practice Address - Street 2:SUITE #206
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-6172
Practice Address - Country:US
Practice Address - Phone:619-225-5762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer