Provider Demographics
NPI:1336639715
Name:KLASKE, CATHERINE (PTA)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:KLASKE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 WAKARUSA DR STE 1000
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-1741
Mailing Address - Country:US
Mailing Address - Phone:178-574-9130
Mailing Address - Fax:
Practice Address - Street 1:1311 WAKARUSA DR STE 1000
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-1741
Practice Address - Country:US
Practice Address - Phone:178-574-9130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-03202225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS14-03202OtherLICENSE