Provider Demographics
NPI:1689041295
Name:SAGE, KATELYN (DPT)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:SAGE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:
Other - Last Name:CHRISTOPHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:332 ABERDEEN DR
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-8533
Mailing Address - Country:US
Mailing Address - Phone:618-535-0188
Mailing Address - Fax:
Practice Address - Street 1:4394 ROUTE 16
Practice Address - Street 2:
Practice Address - City:SHIPMAN
Practice Address - State:IL
Practice Address - Zip Code:62685-6062
Practice Address - Country:US
Practice Address - Phone:618-535-0188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-31
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7683302R00000X, 261QR0400X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist