Provider Demographics
NPI:1316581598
Name:BLECHERTAS, KATHLEEN M (DPT, WCC, FACHE)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:BLECHERTAS
Suffix:
Gender:F
Credentials:DPT, WCC, FACHE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9888 GENESEE
Mailing Address - Street 2:LJ19
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037
Mailing Address - Country:US
Mailing Address - Phone:858-626-6808
Mailing Address - Fax:
Practice Address - Street 1:9888 GENESEE
Practice Address - Street 2:LJ19
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037
Practice Address - Country:US
Practice Address - Phone:858-626-6808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28187225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist