Provider Demographics
NPI:1003934092
Name:DOYLE, KATHLEEN (PTA)
Entity Type:Individual
Prefix:MISS
First Name:KATHLEEN
Middle Name:
Last Name:DOYLE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1690
Mailing Address - Street 2:40 MILLENIUM LANE
Mailing Address - City:NORTH EASTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02651-1690
Mailing Address - Country:US
Mailing Address - Phone:508-255-8475
Mailing Address - Fax:
Practice Address - Street 1:579 BUCK ISLAND RD
Practice Address - Street 2:
Practice Address - City:W YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02673-3200
Practice Address - Country:US
Practice Address - Phone:508-957-7007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3289225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant