Provider Demographics
NPI:1366913634
Name:WOOLBRIGHT, KATELYN M (DPT)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:M
Last Name:WOOLBRIGHT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:M
Other - Last Name:BURGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 GENEVA PKWY N STE A
Mailing Address - Street 2:
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-4594
Mailing Address - Country:US
Mailing Address - Phone:262-249-3500
Mailing Address - Fax:
Practice Address - Street 1:700 GENEVA PKWY N STE A
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-4594
Practice Address - Country:US
Practice Address - Phone:262-249-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070024188225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist