Provider Demographics
NPI:1457440323
Name:DOUBLEDAY, KATHRYN LORAINE (DPT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LORAINE
Last Name:DOUBLEDAY
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 1:432 LAS PALOMAS DR
Mailing Address - Street 2:
Mailing Address - City:PORT HUENEME
Mailing Address - State:CA
Mailing Address - Zip Code:93041-1536
Mailing Address - Country:US
Mailing Address - Phone:805-985-0980
Mailing Address - Fax:805-649-8840
Practice Address - Street 1:11420 N VENTURA AVE
Practice Address - Street 2:#106
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-4175
Practice Address - Country:US
Practice Address - Phone:805-649-8849
Practice Address - Fax:805-649-8840
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 21163225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist