Provider Demographics
NPI:1386358489
Name:LASTINE, KATLYN
Entity type:Individual
Prefix:
First Name:KATLYN
Middle Name:
Last Name:LASTINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 8TH AVE N
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-7670
Mailing Address - Country:US
Mailing Address - Phone:952-933-5085
Mailing Address - Fax:952-931-2159
Practice Address - Street 1:15 8TH AVE N
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-7670
Practice Address - Country:US
Practice Address - Phone:952-933-5085
Practice Address - Fax:952-931-2159
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist