Provider Demographics
NPI:1235265869
Name:POPA, KATHRYN MARY (PT)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:MARY
Last Name:POPA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:N9389 GLACIER DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:WI
Mailing Address - Zip Code:53119-1924
Mailing Address - Country:US
Mailing Address - Phone:262-495-4411
Mailing Address - Fax:
Practice Address - Street 1:727 COUNTY ROAD NN E
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-1011
Practice Address - Country:US
Practice Address - Phone:262-363-3014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1304-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist