Provider Demographics
NPI:1841577996
Name:BREEDLOVE, KATHERINE MORIGAKI (ATC)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:MORIGAKI
Last Name:BREEDLOVE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:ELISSE
Other - Last Name:MORIGAKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:8100 NORTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-4800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8100 NORTHLAND DR
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55431-4800
Practice Address - Country:US
Practice Address - Phone:952-977-0479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001598A2255A2300X
MA19272255A2300X
MN25932255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer