Provider Demographics
NPI:1144774001
Name:DOERR, KATHLEEN JAYNE
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:JAYNE
Last Name:DOERR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4923 CHARTER RD
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-5240
Mailing Address - Country:US
Mailing Address - Phone:916-276-3277
Mailing Address - Fax:
Practice Address - Street 1:4923 CHARTER RD
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-5240
Practice Address - Country:US
Practice Address - Phone:916-276-3277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA164842251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics