Provider Demographics
NPI:1174856843
Name:PATITSAS, KATHRYN M (REHAB INSTRUCTOR)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:M
Last Name:PATITSAS
Suffix:
Gender:F
Credentials:REHAB INSTRUCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35101
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87176-5101
Mailing Address - Country:US
Mailing Address - Phone:505-881-8982
Mailing Address - Fax:505-872-0392
Practice Address - Street 1:5301 PONDEROSA AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-1216
Practice Address - Country:US
Practice Address - Phone:505-881-8982
Practice Address - Fax:505-872-0392
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor