Provider Demographics
NPI:1659772804
Name:FISENNE, KATHARINE GRACE (ATC)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:GRACE
Last Name:FISENNE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10932 CHAMBERLAIN HALL CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-1769
Mailing Address - Country:US
Mailing Address - Phone:980-322-8842
Mailing Address - Fax:
Practice Address - Street 1:10932 CHAMBERLAIN HALL CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-1769
Practice Address - Country:US
Practice Address - Phone:980-322-8842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program