Provider Demographics
NPI:1386856730
Name:KALULE, KATRINA SUZANNE
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:SUZANNE
Last Name:KALULE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:
Other - Last Name:FUHRMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 WARREN RD
Mailing Address - Street 2:UNIT 2
Mailing Address - City:STOW
Mailing Address - State:MA
Mailing Address - Zip Code:01775-3010
Mailing Address - Country:US
Mailing Address - Phone:812-454-4170
Mailing Address - Fax:
Practice Address - Street 1:2 WARREN RD
Practice Address - Street 2:UNIT 2
Practice Address - City:STOW
Practice Address - State:MA
Practice Address - Zip Code:01775-3010
Practice Address - Country:US
Practice Address - Phone:812-454-4170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-05
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3566225200000X
AZ7074A225200000X
IL160-004425225200000X
NH1000225200000X
AZ10250225100000X
MA21137225100000X
TN10077225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant