Provider Demographics
NPI:1609202811
Name:FRALEY, KATHARINE ELIZABETH (PT)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:ELIZABETH
Last Name:FRALEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KATHARINE
Other - Middle Name:ELIZABETH
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1322 DOROTHY LN
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-1869
Mailing Address - Country:US
Mailing Address - Phone:307-632-4368
Mailing Address - Fax:
Practice Address - Street 1:5801 YELLOWSTONE RD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4174
Practice Address - Country:US
Practice Address - Phone:307-638-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY05802251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics