Provider Demographics
NPI:1164509634
Name:CONDAP, KATHLEEN ALICE (PT)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ALICE
Last Name:CONDAP
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:840 N DELANCEY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-1910
Mailing Address - Country:US
Mailing Address - Phone:909-599-8902
Mailing Address - Fax:909-599-8902
Practice Address - Street 1:2125 WRIGHT ST
Practice Address - Street 2:SUITE C-1
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-5814
Practice Address - Country:US
Practice Address - Phone:909-392-3460
Practice Address - Fax:909-392-3140
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPT7157225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics