Provider Demographics
NPI:1538196183
Name:BRANDOLINI, KATHERINE ANNA (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:ANNA
Last Name:BRANDOLINI
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:ANNA
Other - Last Name:MOUNT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:15610 MEITH ST
Mailing Address - Street 2:
Mailing Address - City:FORTVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46040-9609
Mailing Address - Country:US
Mailing Address - Phone:941-302-4306
Mailing Address - Fax:
Practice Address - Street 1:10412 ALLISONVILLE RD STE 112
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038
Practice Address - Country:US
Practice Address - Phone:317-288-7763
Practice Address - Fax:317-288-7765
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05010398A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN05010398AOtherLICENSE NUMBER
PT 21993OtherPHYSICAL THERAPIST