Provider Demographics
NPI:1659315646
Name:RICHARD, KATELYN A (PT)
Entity Type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:A
Last Name:RICHARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:766 N KING ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-1142
Mailing Address - Country:US
Mailing Address - Phone:413-785-1153
Mailing Address - Fax:413-781-4951
Practice Address - Street 1:766 N KING ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-1142
Practice Address - Country:US
Practice Address - Phone:413-586-0230
Practice Address - Fax:413-586-1068
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15150225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY67936OtherBCBS
468260OtherTUFTS
MAY6874601OtherMEDICARE PTAN
MAY68746Medicare ID - Type Unspecified