Provider Demographics
NPI:1174706444
Name:CHITWOOD, KATIE (MPT)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:CHITWOOD
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1346 S MORLEY ST
Mailing Address - Street 2:
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-1943
Mailing Address - Country:US
Mailing Address - Phone:660-263-5488
Mailing Address - Fax:660-263-5750
Practice Address - Street 1:1346 S MORLEY ST
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-1943
Practice Address - Country:US
Practice Address - Phone:660-263-5488
Practice Address - Fax:660-263-5750
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007032913225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist