Provider Demographics
NPI:1538314224
Name:TAT, KATHLEEN P (PT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:P
Last Name:TAT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:P
Other - Last Name:DEMPSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:528 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-1911
Mailing Address - Country:US
Mailing Address - Phone:845-893-5722
Mailing Address - Fax:
Practice Address - Street 1:849 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-3231
Practice Address - Country:US
Practice Address - Phone:845-893-5722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01205200225100000X
NY025571-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist