Provider Demographics
NPI:1184151094
Name:SAMARDZIJA, KATHARYN (DPT)
Entity type:Individual
Prefix:
First Name:KATHARYN
Middle Name:
Last Name:SAMARDZIJA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KATHARYN
Other - Middle Name:
Other - Last Name:PFISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:600 OAKMONT LN STE 600C
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:630-575-6250
Mailing Address - Fax:
Practice Address - Street 1:15887 CUMBERLAND RD STE 103
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-4332
Practice Address - Country:US
Practice Address - Phone:317-674-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05012646A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist