Provider Demographics
NPI:1770177347
Name:HAUGE, KATHRYN MARIS (PT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MARIS
Last Name:HAUGE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2800 PIERCE ST STE 120B
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-3755
Mailing Address - Country:US
Mailing Address - Phone:712-279-3178
Mailing Address - Fax:712-279-3467
Practice Address - Street 1:2800 PIERCE ST STE 120B
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3755
Practice Address - Country:US
Practice Address - Phone:712-279-3178
Practice Address - Fax:712-279-3467
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA105253225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist