Provider Demographics
NPI:1477128528
Name:WILLIAMS, KATHRYN ROSE (PT, DPT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ROSE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2531 112TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-3502
Mailing Address - Country:US
Mailing Address - Phone:763-226-4253
Mailing Address - Fax:
Practice Address - Street 1:1574 154TH AVE NW
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304-4788
Practice Address - Country:US
Practice Address - Phone:763-433-8108
Practice Address - Fax:763-433-8134
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist