Provider Demographics
NPI:1558857797
Name:ROSENTHAL, KATIE S (LAT, ATC)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:S
Last Name:ROSENTHAL
Suffix:
Gender:
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 1:912 SW LAUREN CT
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-2257
Mailing Address - Country:US
Mailing Address - Phone:316-305-4121
Mailing Address - Fax:
Practice Address - Street 1:101 SOCCER PARK DR # C
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6971
Practice Address - Country:US
Practice Address - Phone:316-305-4121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NCLAT-50212255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program