Provider Demographics
NPI:1053557975
Name:HERINGER, KATRINA LEA (PT, DPT, OCS)
Entity type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:LEA
Last Name:HERINGER
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:MS
Other - First Name:KATRINA
Other - Middle Name:LEA
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:902 FLORIN RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-3590
Mailing Address - Country:US
Mailing Address - Phone:916-395-0625
Mailing Address - Fax:916-395-7648
Practice Address - Street 1:902 FLORIN RD
Practice Address - Street 2:SUITE C
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-3590
Practice Address - Country:US
Practice Address - Phone:916-395-0625
Practice Address - Fax:916-395-7648
Is Sole Proprietor?:No
Enumeration Date:2008-12-23
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30421225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABU192ZMedicare PIN