Provider Demographics
NPI:1124450119
Name:CARON, KATY LYNN (DPT)
Entity type:Individual
Prefix:
First Name:KATY
Middle Name:LYNN
Last Name:CARON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:LYNN
Other - Last Name:BASHLINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:312 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:LEECHBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15656-1118
Mailing Address - Country:US
Mailing Address - Phone:717-793-6135
Mailing Address - Fax:
Practice Address - Street 1:2757 LEECHBURG RD
Practice Address - Street 2:
Practice Address - City:LOWER BURRELL
Practice Address - State:PA
Practice Address - Zip Code:15068-3138
Practice Address - Country:US
Practice Address - Phone:724-337-6522
Practice Address - Fax:724-337-0630
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT022893225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1028534490001Medicaid