Provider Demographics
NPI:1861565616
Name:DERSCHEID, KATHERINE ELIZABETH (PT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ELIZABETH
Last Name:DERSCHEID
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:E
Other - Last Name:KOLSHAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:33900 HARPER AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:586-350-2644
Mailing Address - Fax:586-541-3735
Practice Address - Street 1:224B JOHNSON FERRY RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-3820
Practice Address - Country:US
Practice Address - Phone:470-300-6670
Practice Address - Fax:470-300-6671
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015840225100000X
MN92922251X0800X
AZ73232251X0800X
GAPT013341225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic