Provider Demographics
NPI:1508891102
Name:KANGAS, KATHLEEN FARIS (DPT)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:FARIS
Last Name:KANGAS
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 1:2133 SEDGES AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-2970
Mailing Address - Country:US
Mailing Address - Phone:202-288-5389
Mailing Address - Fax:
Practice Address - Street 1:109 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2725
Practice Address - Country:US
Practice Address - Phone:202-288-5389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL40180225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist