Provider Demographics
NPI:1376295451
Name:GRADY, KATRINA I (PTA)
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:I
Last Name:GRADY
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 1:2422 KNIGHTSBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-3480
Mailing Address - Country:US
Mailing Address - Phone:602-568-6390
Mailing Address - Fax:
Practice Address - Street 1:7501 W 15TH AVE
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46406-2267
Practice Address - Country:US
Practice Address - Phone:219-977-2092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant