Provider Demographics
NPI:1194102459
Name:PRATER, KATRINA (LMT)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:PRATER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5551 HILLIARD ROME OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-7287
Mailing Address - Country:US
Mailing Address - Phone:614-850-0500
Mailing Address - Fax:614-850-0540
Practice Address - Street 1:5551 HILLIARD ROME OFFICE PARK
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-7287
Practice Address - Country:US
Practice Address - Phone:614-850-0500
Practice Address - Fax:614-850-0540
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH022079225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist