Provider Demographics
NPI:1932681095
Name:LAURICH, KATELYN (PT)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:LAURICH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:
Other - Last Name:LONGANBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:841 W WASHINGTON ST STE 500
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4139
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:841 W WASHINGTON ST STE 500
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855
Practice Address - Country:US
Practice Address - Phone:906-228-2595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist