Provider Demographics
NPI:1093076333
Name:MCLOUGHLIN, KATHLEEN A (PT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:MCLOUGHLIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6246 E PIMA ST
Mailing Address - Street 2:SUITE 180
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-3156
Mailing Address - Country:US
Mailing Address - Phone:520-318-1996
Mailing Address - Fax:529-320-1175
Practice Address - Street 1:6246 E PIMA ST
Practice Address - Street 2:SUITE 180
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-3156
Practice Address - Country:US
Practice Address - Phone:520-318-1996
Practice Address - Fax:529-320-1175
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5398225100000X
NC1169225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist