Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 05011691A | IN |
NPI | 1063502847 |
---|---|
Provider Name | Kathryn L. Werda |
First Address | South Bend, IN 46635-1571 |
Second Address | South Bend, IN 46635-1571 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 13/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201293020 | (05) | IN |
LAY68088 | BCBS OF MA (01) | MA |