Provider Demographics
NPI:1821123332
Name:FLODQUIST, KATHRYN (PT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:FLODQUIST
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:LOYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:27 DEPOT ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-2601
Mailing Address - Country:US
Mailing Address - Phone:860-274-4092
Mailing Address - Fax:860-274-4099
Practice Address - Street 1:27 DEPOT ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795-2601
Practice Address - Country:US
Practice Address - Phone:860-274-4092
Practice Address - Fax:860-274-4099
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006010225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist