Provider Demographics
NPI:1952840266
Name:KANE, KATHERINE MCLELLAND (PT, DPT, ATC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MCLELLAND
Last Name:KANE
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:MCLELLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:433 W 63RD ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-4719
Mailing Address - Country:US
Mailing Address - Phone:850-380-0590
Mailing Address - Fax:
Practice Address - Street 1:77 BOONE VLG
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-1231
Practice Address - Country:US
Practice Address - Phone:317-873-2033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL46332255A2300X
IN05013994A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer