Provider Demographics
NPI:1619386760
Name:AANERUD, KATIE ANN (ATC)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:ANN
Last Name:AANERUD
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:ANN
Other - Last Name:DIETRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:1106 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2416
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:235 ATASCADERO RD
Practice Address - Street 2:
Practice Address - City:MORRO BAY
Practice Address - State:CA
Practice Address - Zip Code:93442-1516
Practice Address - Country:US
Practice Address - Phone:805-235-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-02
Last Update Date:2014-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer