Provider Demographics
NPI:1821419516
Name:BUSKIRK, KATHLEEN ANN (PTA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANN
Last Name:BUSKIRK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KATHIE
Other - Middle Name:ANN
Other - Last Name:BUSKIRK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:2570 21ST ST
Mailing Address - Street 2:
Mailing Address - City:GERING
Mailing Address - State:NE
Mailing Address - Zip Code:69341-1956
Mailing Address - Country:US
Mailing Address - Phone:308-440-9924
Mailing Address - Fax:
Practice Address - Street 1:2570 21ST ST
Practice Address - Street 2:
Practice Address - City:GERING
Practice Address - State:NE
Practice Address - Zip Code:69341
Practice Address - Country:US
Practice Address - Phone:308-440-9924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant