Provider Demographics
NPI:1346540887
Name:MAGNUSON, KATHLEEN MARIE
Entity Type:Individual
Prefix:MISS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:MAGNUSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21042 E ARROW HWY
Mailing Address - Street 2:APT. 79
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-1400
Mailing Address - Country:US
Mailing Address - Phone:541-231-3925
Mailing Address - Fax:
Practice Address - Street 1:21042 E ARROW HWY
Practice Address - Street 2:APT. 79
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-1400
Practice Address - Country:US
Practice Address - Phone:541-231-3925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist