Basic Information
| Provider Information | |||||||||
| NPI: | 1316257637 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLACKBURN | ||||||||
| FirstName: | KATE | ||||||||
| MiddleName: | ERICA | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2315 HIGHWAY K | ||||||||
| Address2: | |||||||||
| City: | O FALLON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633688659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6362651505 | ||||||||
| FaxNumber: | 6362662112 | ||||||||
| Practice Location | |||||||||
| Address1: | 1015 MEYER RD | ||||||||
| Address2: | |||||||||
| City: | WENTZVILLE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633853457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6362651505 | ||||||||
| FaxNumber: | 6362662112 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2010 | ||||||||
| LastUpdateDate: | 05/20/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2008005693 | MO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.