Provider Demographics
NPI:1124356274
Name:DALEY, KATHY A (PT)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:A
Last Name:DALEY
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 1:5171 CUB LAKE RD
Mailing Address - Street 2:SUITE C 360
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-7888
Mailing Address - Country:US
Mailing Address - Phone:928-537-0248
Mailing Address - Fax:928-537-0251
Practice Address - Street 1:5171 CUB LAKE RD
Practice Address - Street 2:SUITE C 360
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7888
Practice Address - Country:US
Practice Address - Phone:928-537-0248
Practice Address - Fax:928-537-0251
Is Sole Proprietor?:No
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8488PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ8488PTOtherAZ PT LICENSE