Provider Demographics
NPI:1861530230
Name:LONG, KATHERINE JANE (PT)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:JANE
Last Name:LONG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:5604 S NEWTON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-2319
Mailing Address - Country:US
Mailing Address - Phone:417-889-6925
Mailing Address - Fax:417-236-2481
Practice Address - Street 1:700 E CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:MONETT
Practice Address - State:MO
Practice Address - Zip Code:65708-1436
Practice Address - Country:US
Practice Address - Phone:417-236-2480
Practice Address - Fax:417-236-2481
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO01890225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist