Provider Demographics
NPI:1336343391
Name:ADKINS, KATI W (MPT, CSCS,CLT)
Entity type:Individual
Prefix:
First Name:KATI
Middle Name:W
Last Name:ADKINS
Suffix:
Gender:F
Credentials:MPT, CSCS,CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5017 STONEHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53716-2323
Mailing Address - Country:US
Mailing Address - Phone:608-223-1984
Mailing Address - Fax:
Practice Address - Street 1:407 N 8TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT HOREB
Practice Address - State:WI
Practice Address - Zip Code:53572-1872
Practice Address - Country:US
Practice Address - Phone:608-437-5511
Practice Address - Fax:608-437-9603
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9576024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40464100Medicaid