Provider Demographics
NPI:1982636338
Name:VLACH, KATHARINE J (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:KATHARINE
Middle Name:J
Last Name:VLACH
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MISS
Other - First Name:KATHARINE
Other - Middle Name:J
Other - Last Name:ZEIGLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:P.O. BOX 1533
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51102-1533
Mailing Address - Country:US
Mailing Address - Phone:712-234-8760
Mailing Address - Fax:712-234-8765
Practice Address - Street 1:915 PIERCE ST.
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1031
Practice Address - Country:US
Practice Address - Phone:712-234-8760
Practice Address - Fax:712-234-8765
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03433225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA723261Medicaid
NE42147982000Medicaid
IA0728261Medicaid
IAP00364860OtherR.R MEDICARE
NE42147982000Medicaid
IAP00364860OtherR.R MEDICARE
IAI17891Medicare UPIN