Provider Demographics
NPI:1538448477
Name:VASKO, KATIE (PT)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:
Last Name:VASKO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:KATIE
Other - Middle Name:L
Other - Last Name:MAPES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:206 PAGE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2418
Mailing Address - Country:US
Mailing Address - Phone:517-783-6670
Mailing Address - Fax:517-783-5310
Practice Address - Street 1:206 PAGE AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2418
Practice Address - Country:US
Practice Address - Phone:517-783-6670
Practice Address - Fax:517-783-5310
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015664225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM94500OtherMEDICARE PTAN