Provider Demographics
NPI:1790335800
Name:GATICA, KATIE M (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:M
Last Name:GATICA
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 1:2333 S TACKETTS CIR
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645
Mailing Address - Country:US
Mailing Address - Phone:603-369-0872
Mailing Address - Fax:855-753-0111
Practice Address - Street 1:2333 S TACKETT'S CIR
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645
Practice Address - Country:US
Practice Address - Phone:603-369-0872
Practice Address - Fax:855-753-0111
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-19
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKPHYP26252251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics