Provider Demographics
NPI:1124687272
Name:ALDER, KATIE JO (PTA)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:JO
Last Name:ALDER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:JO
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1312 STATE HIGHWAY 39
Mailing Address - Street 2:
Mailing Address - City:SAINT EDWARD
Mailing Address - State:NE
Mailing Address - Zip Code:68660-5544
Mailing Address - Country:US
Mailing Address - Phone:402-750-2869
Mailing Address - Fax:
Practice Address - Street 1:723 W FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:NE
Practice Address - Zip Code:68620-1725
Practice Address - Country:US
Practice Address - Phone:402-395-3187
Practice Address - Fax:402-395-3169
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE799225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant