Provider Demographics
NPI:1932456118
Name:FEAMSTER, KATIE (KT) MARY (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MS
First Name:KATIE (KT)
Middle Name:MARY
Last Name:FEAMSTER
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-2813
Mailing Address - Country:US
Mailing Address - Phone:626-324-1728
Mailing Address - Fax:
Practice Address - Street 1:501 S MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-2813
Practice Address - Country:US
Practice Address - Phone:626-324-1728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA279092251E1200X, 2255A2300X, 225600000X, 225700000X, 226300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No2251E1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistErgonomics
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist
No226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist