Provider Demographics
NPI:1306980230
Name:FRIEND, KATHLEEN M (PT)
Entity type:Individual
Prefix:MISS
First Name:KATHLEEN
Middle Name:M
Last Name:FRIEND
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10305 DAWSONS CREEK BLVD
Mailing Address - Street 2:STE F
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1914
Mailing Address - Country:US
Mailing Address - Phone:260-497-0328
Mailing Address - Fax:260-497-0904
Practice Address - Street 1:10305 DAWSONS CREEK BLVD
Practice Address - Street 2:STE F
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1914
Practice Address - Country:US
Practice Address - Phone:260-497-0328
Practice Address - Fax:260-497-0904
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05006769A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist