Provider Demographics
NPI:1073970372
Name:WILSON, KATHARINE R (MSPT, CHT)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:R
Last Name:WILSON
Suffix:
Gender:F
Credentials:MSPT, CHT
Other - Prefix:
Other - First Name:KATHARINE
Other - Middle Name:R
Other - Last Name:BISHOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2655 RIDGEWAY AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4296
Mailing Address - Country:US
Mailing Address - Phone:585-368-6600
Mailing Address - Fax:585-368-6601
Practice Address - Street 1:2655 RIDGEWAY AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4296
Practice Address - Country:US
Practice Address - Phone:585-368-6600
Practice Address - Fax:585-368-6601
Is Sole Proprietor?:No
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021914225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist