Provider Demographics
NPI:1194375857
Name:WAREJCKA, KATELYNN NICOLE (PT, DPT, ATC)
Entity Type:Individual
Prefix:
First Name:KATELYNN
Middle Name:NICOLE
Last Name:WAREJCKA
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:KATELYNN
Other - Middle Name:N
Other - Last Name:RUNGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22146 NACHTIGAL RD
Mailing Address - Street 2:
Mailing Address - City:HARROLD
Mailing Address - State:SD
Mailing Address - Zip Code:57536-7102
Mailing Address - Country:US
Mailing Address - Phone:605-695-1767
Mailing Address - Fax:
Practice Address - Street 1:825 E 8TH ST STE 204
Practice Address - Street 2:
Practice Address - City:WINNER
Practice Address - State:SD
Practice Address - Zip Code:57580-2633
Practice Address - Country:US
Practice Address - Phone:605-842-7188
Practice Address - Fax:605-842-7189
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2209225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist