Provider Demographics
NPI:1891464384
Name:IRWIN, KATLYN MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:KATLYN
Middle Name:MARIE
Last Name:IRWIN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5035 1/2 MARTIN DR
Mailing Address - Street 2:
Mailing Address - City:EAST PETERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17520-1620
Mailing Address - Country:US
Mailing Address - Phone:717-575-7157
Mailing Address - Fax:
Practice Address - Street 1:722 FURNACE HILLS PIKE
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-7954
Practice Address - Country:US
Practice Address - Phone:717-626-2071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI003456225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant