Provider Demographics
NPI:1720872286
Name:VANDIFORD, KATHERINE (PT, DPT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:VANDIFORD
Suffix:
Gender:
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:SICKINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:333 W 57TH ST APT 214
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3116
Mailing Address - Country:US
Mailing Address - Phone:937-267-6591
Mailing Address - Fax:
Practice Address - Street 1:150 AMSTERDAM AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-3902
Practice Address - Country:US
Practice Address - Phone:646-795-3850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0494242251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics