Provider Demographics
NPI:1225073893
Name:GLESSING, KATIE BETH (PT)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:BETH
Last Name:GLESSING
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 10TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-6913
Mailing Address - Country:US
Mailing Address - Phone:701-839-4102
Mailing Address - Fax:
Practice Address - Street 1:2900 10TH ST SW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-6913
Practice Address - Country:US
Practice Address - Phone:701-839-4102
Practice Address - Fax:701-838-9603
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6920225100000X
NE2344225100000X
ND1198225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDN711364Medicare PIN
NDP00225946Medicare PIN