Provider Demographics
NPI:1083682041
Name:ELSTON, KATHERINE DIANE (PT)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:DIANE
Last Name:ELSTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 N WEBB RD
Mailing Address - Street 2:104
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3407
Mailing Address - Country:US
Mailing Address - Phone:316-630-9944
Mailing Address - Fax:316-630-9945
Practice Address - Street 1:2020 N WEBB RD
Practice Address - Street 2:104
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3407
Practice Address - Country:US
Practice Address - Phone:316-630-9944
Practice Address - Fax:316-630-9945
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-00916225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS140638Medicare PIN