Provider Demographics
NPI:1407466188
Name:MERTLIK, KATHERINE NOREE (PTA)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:NOREE
Last Name:MERTLIK
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 1:4400 S 45TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-1117
Mailing Address - Country:US
Mailing Address - Phone:402-310-2121
Mailing Address - Fax:
Practice Address - Street 1:4400 S 45TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-1117
Practice Address - Country:US
Practice Address - Phone:402-310-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant