Provider Demographics
NPI:1902239825
Name:SEBASTIAN, KATHERINE (PT)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:
Last Name:SEBASTIAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:SWANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2795 PILOT KNOB ROAD
Mailing Address - Street 2:SUITE #100
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-1176
Mailing Address - Country:US
Mailing Address - Phone:651-994-9644
Mailing Address - Fax:651-994-8962
Practice Address - Street 1:14635 PENNOCK AVE
Practice Address - Street 2:SUITE #300
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-6430
Practice Address - Country:US
Practice Address - Phone:651-994-9644
Practice Address - Fax:651-994-8962
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9432225100000X, 174400000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN9432OtherSTATE