Provider Demographics
NPI:1568756534
Name:TAGGART, KATRINA ROSE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:ROSE
Last Name:TAGGART
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 SW WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-1648
Mailing Address - Country:US
Mailing Address - Phone:785-806-8756
Mailing Address - Fax:
Practice Address - Street 1:1315 SW 6TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1581
Practice Address - Country:US
Practice Address - Phone:785-233-5500
Practice Address - Fax:785-233-5512
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1102906225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist