Provider Demographics
NPI:1376821926
Name:TATE, KATHY LEA (DPT)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:LEA
Last Name:TATE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CRAVEN RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07046-1424
Mailing Address - Country:US
Mailing Address - Phone:201-344-8811
Mailing Address - Fax:
Practice Address - Street 1:141 W PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607-1333
Practice Address - Country:US
Practice Address - Phone:201-843-0026
Practice Address - Fax:201-843-0032
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0033872-1225100000X
NJ40QA01502000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist