Provider Demographics
NPI:1063523215
Name:GLOSE, KATHERINE (ATC)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:
Last Name:GLOSE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:SAMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:173 MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-2462
Mailing Address - Country:US
Mailing Address - Phone:716-713-1927
Mailing Address - Fax:
Practice Address - Street 1:2001 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14208-1035
Practice Address - Country:US
Practice Address - Phone:716-713-1927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0017772255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer