Provider Demographics
NPI:1164669438
Name:DIBARTOLOMEO, KATHLEEN (PT)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:
Last Name:DIBARTOLOMEO
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 1:36 COMMONS WAY
Mailing Address - Street 2:APT 1
Mailing Address - City:LAKE PLACID
Mailing Address - State:NY
Mailing Address - Zip Code:12946-1588
Mailing Address - Country:US
Mailing Address - Phone:518-897-2317
Mailing Address - Fax:518-891-5097
Practice Address - Street 1:2233 STATE ROUTE 86
Practice Address - Street 2:
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-5644
Practice Address - Country:US
Practice Address - Phone:518-897-2317
Practice Address - Fax:518-891-5097
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030538225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00363213Medicaid
NY030538OtherLICENSE
NY725853OtherBLUE CROSS
NY030538OtherLICENSE