Provider Demographics
NPI:1184288094
Name:PICKETT, KATHRYN E (DPT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:E
Last Name:PICKETT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:LYMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1003 OXFORD LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-7744
Mailing Address - Country:US
Mailing Address - Phone:608-921-3675
Mailing Address - Fax:
Practice Address - Street 1:557 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-2907
Practice Address - Country:US
Practice Address - Phone:608-754-6000
Practice Address - Fax:608-755-7892
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
COPTL.0014304225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist