Provider Demographics
NPI:1114570678
Name:HEDLUND, KATELYN NICOLE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:NICOLE
Last Name:HEDLUND
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 1:1530 NEMAHA ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-4729
Mailing Address - Country:US
Mailing Address - Phone:308-730-2663
Mailing Address - Fax:
Practice Address - Street 1:6101 S 56TH ST STE 1
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-3392
Practice Address - Country:US
Practice Address - Phone:402-420-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3988225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist