Provider Demographics
NPI:1871256784
Name:REARDON, KATHERINE CHASE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:CHASE
Last Name:REARDON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:KATHERINE
Other - Middle Name:CHASE
Other - Last Name:BRADSHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1155 ESSEX RD APT 2
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-9547
Mailing Address - Country:US
Mailing Address - Phone:209-549-6487
Mailing Address - Fax:
Practice Address - Street 1:160 FLYNN AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5400
Practice Address - Country:US
Practice Address - Phone:802-864-6262
Practice Address - Fax:802-864-6252
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-18
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0134300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist