Provider Demographics
NPI:1316366206
Name:NALL, KATHRYN EMILY (DPT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:EMILY
Last Name:NALL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:
Other - Last Name:ALBERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1643 NEW PORT VISTA DR
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-9383
Mailing Address - Country:US
Mailing Address - Phone:262-323-2817
Mailing Address - Fax:
Practice Address - Street 1:1643 NEW PORT VISTA DR
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024-9383
Practice Address - Country:US
Practice Address - Phone:262-323-2817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12603-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist