Provider Demographics
NPI:1205965126
Name:WEATHERHOGG, KATIE MARIE (MD)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE
Last Name:WEATHERHOGG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:MARIE
Other - Last Name:RAHMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8702
Mailing Address - Country:US
Mailing Address - Phone:970-495-8490
Mailing Address - Fax:970-495-8499
Practice Address - Street 1:2695 ROCKY MOUNTAIN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-8702
Practice Address - Country:US
Practice Address - Phone:970-495-8490
Practice Address - Fax:970-495-8499
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20090128122081P0010X
NC134800208100000X
CODR.0055231208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO29101212Medicaid
CO42558YLB8Medicare PIN