Provider Demographics
NPI:1295438802
Name:BISHOP, KATELYN MARIE (PTA)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:MARIE
Last Name:BISHOP
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:MARIE
Other - Last Name:SPANJER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1453 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:NE
Mailing Address - Zip Code:68333-2000
Mailing Address - Country:US
Mailing Address - Phone:402-239-6924
Mailing Address - Fax:
Practice Address - Street 1:209 W 3RD ST
Practice Address - Street 2:
Practice Address - City:WILBER
Practice Address - State:NE
Practice Address - Zip Code:68465-3144
Practice Address - Country:US
Practice Address - Phone:402-821-3320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2052225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant