Individual
KATHARINE MARIE LEUTHOLD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
SPE 150X, BROOKINGS, SD 57007-0001
(712) 470-5364
(605) 688-5999
Mailing address
526 5TH AVE S APT H2, BROOKINGS, SD 57006-3338
(712) 470-5364
(605) 688-5999
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0308
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000000167
ATHLETIC TRAINING
SD
Enumeration date
01/25/2010
Last updated
01/25/2010
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