Provider Demographics
NPI:1902358419
Name:LANSING, KATHERINE (PTA)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:LANSING
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 1:9 14TH AVE W
Mailing Address - Street 2:
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860-5321
Mailing Address - Country:US
Mailing Address - Phone:406-883-4378
Mailing Address - Fax:
Practice Address - Street 1:9 14TH AVE W
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-5321
Practice Address - Country:US
Practice Address - Phone:406-883-4378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-01
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52424225200000X
MTPTP-PTA-LIC-9461225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant