Provider Demographics
NPI:1467847707
Name:ETUKEREN, KATHERINE R (DPT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:R
Last Name:ETUKEREN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:R
Other - Last Name:BLATTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 5718
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59903-5718
Mailing Address - Country:US
Mailing Address - Phone:406-756-0134
Mailing Address - Fax:406-309-2579
Practice Address - Street 1:7525 E BROADWAY RD STE 6
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85208-1156
Practice Address - Country:US
Practice Address - Phone:480-354-2911
Practice Address - Fax:480-984-3169
Is Sole Proprietor?:No
Enumeration Date:2015-04-03
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11142225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist