Provider Demographics
NPI:1508003674
Name:LOMBARDO, KATHLEEN JOY GOZUM (DPT)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN JOY
Middle Name:GOZUM
Last Name:LOMBARDO
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 1:18271 MCDURMOTT W
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-6754
Mailing Address - Country:US
Mailing Address - Phone:949-752-2227
Mailing Address - Fax:
Practice Address - Street 1:18271 MCDURMOTT W
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6754
Practice Address - Country:US
Practice Address - Phone:949-752-2227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-12
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35210225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist