Provider Demographics
NPI:1710544465
Name:RADD, KATHERINE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:
Last Name:RADD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 MARTHA KAYE DR APT 302
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-7020
Mailing Address - Country:US
Mailing Address - Phone:740-232-8749
Mailing Address - Fax:
Practice Address - Street 1:4701 COLUMBUS ST STE 100
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6725
Practice Address - Country:US
Practice Address - Phone:757-922-1840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-28
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305213912225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist