Provider Demographics
NPI:1578963948
Name:PELLEGRINO, KATHLEEN (PT)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:PELLEGRINO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:O'DAY
Other - Last Name:KACEVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:25 HOLT RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NH
Mailing Address - Zip Code:03031-3007
Mailing Address - Country:US
Mailing Address - Phone:508-561-2092
Mailing Address - Fax:
Practice Address - Street 1:40 CROSBY ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NH
Practice Address - Zip Code:03055-4707
Practice Address - Country:US
Practice Address - Phone:603-673-7061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3924225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist