Basic Information
| Provider Information | |||||||||
| NPI: | 1679010003 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CREECH | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3656 SHADOW RIDGE DR | ||||||||
| Address2: | |||||||||
| City: | HIGH POINT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272658403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367603634 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3656 SHADOW RIDGE DR | ||||||||
| Address2: | |||||||||
| City: | HIGH POINT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272658403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367603634 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2017 | ||||||||
| LastUpdateDate: | 01/24/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 10087 | NC | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.