Provider Demographics
NPI:1639140262
Name:NASLUND, KATIE L (MSPT)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:L
Last Name:NASLUND
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 1:1109 W CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:BERESFORD
Mailing Address - State:SD
Mailing Address - Zip Code:57004-1524
Mailing Address - Country:US
Mailing Address - Phone:605-763-5096
Mailing Address - Fax:605-763-2206
Practice Address - Street 1:1109 W CEDAR ST
Practice Address - Street 2:
Practice Address - City:BERESFORD
Practice Address - State:SD
Practice Address - Zip Code:57004-1524
Practice Address - Country:US
Practice Address - Phone:605-763-5096
Practice Address - Fax:605-763-2206
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03841225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
42147982000OtherNEBRASKA MEDICAID
IA0474916Medicaid
5835808OtherSOUTH DAKOTA MEDICAID
IA0474916Medicaid
I16287Medicare UPIN