Provider Demographics
NPI:1356649586
Name:RESOP, KATHERINE A (DPT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:A
Last Name:RESOP
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 E MERRILL AVE
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-2938
Mailing Address - Country:US
Mailing Address - Phone:920-539-0925
Mailing Address - Fax:
Practice Address - Street 1:951 YORK DR
Practice Address - Street 2:SUITE 103
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115
Practice Address - Country:US
Practice Address - Phone:469-727-7246
Practice Address - Fax:469-727-7833
Is Sole Proprietor?:No
Enumeration Date:2011-03-11
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1200767225100000X
CA36939225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist