Provider Demographics
NPI:1760445951
Name:LOWERY, KATHERINE MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:MARIE
Last Name:LOWERY
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 1:1650 INDIANTOWN RD
Mailing Address - Street 2:
Mailing Address - City:HENRY
Mailing Address - State:IL
Mailing Address - Zip Code:61537-9227
Mailing Address - Country:US
Mailing Address - Phone:309-364-3905
Mailing Address - Fax:309-364-3567
Practice Address - Street 1:1650 INDIANTOWN RD
Practice Address - Street 2:
Practice Address - City:HENRY
Practice Address - State:IL
Practice Address - Zip Code:61537-9227
Practice Address - Country:US
Practice Address - Phone:309-364-3905
Practice Address - Fax:309-364-3567
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-013230225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILQ57085Medicare UPIN
IL212607Medicare ID - Type Unspecified