Provider Demographics
NPI:1316647860
Name:RHEINGANS, KATELYNN MAE (LAT, ATC)
Entity type:Individual
Prefix:
First Name:KATELYNN
Middle Name:MAE
Last Name:RHEINGANS
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 E 56TH ST # 300
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2904
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4700 E 56TH ST # 300
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2904
Practice Address - Country:US
Practice Address - Phone:563-421-4376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0054392255A2300X
IA0974582255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA097458OtherSTATE OF IOWA DEPARTMENT OF PUBLIC HEALTH
IL096.005439OtherDEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION
2000036992OtherBOARD OF CERTIFICATION