Provider Demographics
NPI:1215384136
Name:SLAUGHTER, KATLIN E (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KATLIN
Middle Name:E
Last Name:SLAUGHTER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KATLIN
Other - Middle Name:E
Other - Last Name:HANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MS 21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:612-341-5191
Mailing Address - Fax:
Practice Address - Street 1:2220 RIVERSIDE AVE FL 5
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454
Practice Address - Country:US
Practice Address - Phone:612-341-5191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-20
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
WI13390-24225100000X
MN10477225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist