Provider Demographics
NPI:1720354251
Name:PERTILE, KATELYN LEE (DPT)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:LEE
Last Name:PERTILE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 ELK MOUNTAIN CIR
Mailing Address - Street 2:
Mailing Address - City:GREEN RIVER
Mailing Address - State:WY
Mailing Address - Zip Code:82935-5512
Mailing Address - Country:US
Mailing Address - Phone:307-871-1693
Mailing Address - Fax:
Practice Address - Street 1:1220 ELK MOUNTAIN CIR
Practice Address - Street 2:
Practice Address - City:GREEN RIVER
Practice Address - State:WY
Practice Address - Zip Code:82935-5512
Practice Address - Country:US
Practice Address - Phone:701-426-5433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2017-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT-1412225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist