Provider Demographics
NPI:1497278014
Name:KATHLEEN MCDONOUGH PHYSICAL THERAPY ASSOCIATES PC
Entity Type:Organization
Organization Name:KATHLEEN MCDONOUGH PHYSICAL THERAPY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:HOPE
Authorized Official - Last Name:MCDONOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:415-272-3966
Mailing Address - Street 1:114 MEADOWCROFT DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-1507
Mailing Address - Country:US
Mailing Address - Phone:415-272-3966
Mailing Address - Fax:415-785-7012
Practice Address - Street 1:224 GREENFIELD AVE STE 1
Practice Address - Street 2:
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960-2472
Practice Address - Country:US
Practice Address - Phone:415-272-3966
Practice Address - Fax:415-457-4200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-25
Last Update Date:2019-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty