Provider Demographics
NPI:1093260408
Name:WARNER, KATELYN MARIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:MARIE
Last Name:WARNER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:MARIE
Other - Last Name:SHIMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:850 43RD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-8401
Mailing Address - Country:US
Mailing Address - Phone:309-743-2070
Mailing Address - Fax:309-743-2073
Practice Address - Street 1:2109 CEDARWOOD DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-2670
Practice Address - Country:US
Practice Address - Phone:563-288-6787
Practice Address - Fax:563-288-6719
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA082231225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist