Provider Demographics
NPI:1700932191
Name:PETRA, CATHERINE MARIE (MS, ATC)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:MARIE
Last Name:PETRA
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:MS
Other - First Name:CATHERINE
Other - Middle Name:MARIE
Other - Last Name:LAFOREST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, ATC
Mailing Address - Street 1:47424 319TH ST
Mailing Address - Street 2:
Mailing Address - City:ELK POINT
Mailing Address - State:SD
Mailing Address - Zip Code:57025-6630
Mailing Address - Country:US
Mailing Address - Phone:605-356-2558
Mailing Address - Fax:
Practice Address - Street 1:1305 W 18TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-0401
Practice Address - Country:US
Practice Address - Phone:605-328-1759
Practice Address - Fax:605-328-1857
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD00442255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer