Provider Demographics
NPI:1891209813
Name:ETCHER, KATIE MARIE (PT, DPT, OCS)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE
Last Name:ETCHER
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 N MONTEREY ST APT K
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-2527
Mailing Address - Country:US
Mailing Address - Phone:818-268-4667
Mailing Address - Fax:
Practice Address - Street 1:404 N MONTEREY ST APT K
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-2527
Practice Address - Country:US
Practice Address - Phone:818-268-4667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-29
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA427772251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic