Provider Demographics
NPI:1548203649
Name:DECKER, KATHERINE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:
Last Name:DECKER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:GREYSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MPT
Mailing Address - Street 1:11 EMERALD CT
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-3921
Mailing Address - Country:US
Mailing Address - Phone:321-848-7281
Mailing Address - Fax:
Practice Address - Street 1:2040 HIGHWAY A1A STE 203
Practice Address - Street 2:
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-3566
Practice Address - Country:US
Practice Address - Phone:321-773-8989
Practice Address - Fax:321-773-8990
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL33694225100000X
MD23609225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU2710ZMedicare PIN