Provider Demographics
NPI:1073800561
Name:ROCKAFELLOW, KATHRYN LEE (DPT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LEE
Last Name:ROCKAFELLOW
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3385 DEXTER CT
Mailing Address - Street 2:STE 301
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3494
Mailing Address - Country:US
Mailing Address - Phone:563-344-6645
Mailing Address - Fax:563-441-7796
Practice Address - Street 1:3385 DEXTER CT
Practice Address - Street 2:STE 301
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3494
Practice Address - Country:US
Practice Address - Phone:563-344-6645
Practice Address - Fax:563-441-7796
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004840225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA213140009Medicare PIN