Provider Demographics
NPI:1215378120
Name:SCHLOSSER, KATIE LYNN (PT, DPT, PCS, CLT)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:LYNN
Last Name:SCHLOSSER
Suffix:
Gender:F
Credentials:PT, DPT, PCS, CLT
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:LYNN
Other - Last Name:SIEGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:508 13TH ST E
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-4179
Mailing Address - Country:US
Mailing Address - Phone:406-989-1480
Mailing Address - Fax:
Practice Address - Street 1:508 13TH ST E
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-4179
Practice Address - Country:US
Practice Address - Phone:406-989-1480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT3176225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND52114Medicaid
ND52114Medicaid