Provider Demographics
NPI:1326639543
Name:KATHERINE V PACE KVP CONCIERGE THERAPY
Entity Type:Organization
Organization Name:KATHERINE V PACE KVP CONCIERGE THERAPY
Other - Org Name:HAVEN PELVIC PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:551-358-3341
Mailing Address - Street 1:84 ELM ST STE E
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2181
Mailing Address - Country:US
Mailing Address - Phone:908-644-8213
Mailing Address - Fax:732-510-0716
Practice Address - Street 1:84 ELM ST STE E
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2181
Practice Address - Country:US
Practice Address - Phone:908-644-8213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-30
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1881841294OtherNPI