Provider Demographics
NPI:1932226461
Name:MORELAND, KATRINA BLAINE (PT)
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:BLAINE
Last Name:MORELAND
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 1:15910 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50323-2282
Mailing Address - Country:US
Mailing Address - Phone:515-278-8151
Mailing Address - Fax:515-276-3194
Practice Address - Street 1:5900 NW 86TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-2284
Practice Address - Country:US
Practice Address - Phone:515-278-8151
Practice Address - Fax:515-278-8155
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04015225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0665430Medicaid
IAI19172Medicare PIN
IA0665430Medicaid