Provider Demographics
NPI:1699372292
Name:DAMMER, KATE SHULTS (PT, DPT)
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:SHULTS
Last Name:DAMMER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:LIVESAY
Other - Last Name:SHULTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:639 HURLEY AVE
Mailing Address - Street 2:
Mailing Address - City:HURLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12443-5123
Mailing Address - Country:US
Mailing Address - Phone:845-514-4970
Mailing Address - Fax:
Practice Address - Street 1:280 ROUT 299
Practice Address - Street 2:SUITE 1
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528
Practice Address - Country:US
Practice Address - Phone:845-691-9169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046194225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist