Provider Demographics
NPI:1518746536
Name:STARR, KATHLEEN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:STARR
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5433 NEW MILLS RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-2247
Mailing Address - Country:US
Mailing Address - Phone:617-955-9337
Mailing Address - Fax:
Practice Address - Street 1:5433 NEW MILLS RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-2247
Practice Address - Country:US
Practice Address - Phone:760-960-1654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA304576208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation