Provider Demographics
NPI:1235505488
Name:KOLTZ, KATRINA LORAE (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:LORAE
Last Name:KOLTZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MISS
Other - First Name:KATRINA
Other - Middle Name:LORAE
Other - Last Name:HOPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18215 HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-3609
Mailing Address - Country:US
Mailing Address - Phone:708-444-2563
Mailing Address - Fax:708-444-2769
Practice Address - Street 1:18215 HARLEM AVE
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-3609
Practice Address - Country:US
Practice Address - Phone:708-444-2563
Practice Address - Fax:708-444-2769
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070021526225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist