Provider Demographics
NPI:1598277063
Name:D'ADDAMIO, KATHRYN ELIZABETH (LMT)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:ELIZABETH
Last Name:D'ADDAMIO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:E
Other - Last Name:ROSALIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:PO BOX 32676
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-2676
Mailing Address - Country:US
Mailing Address - Phone:520-609-2159
Mailing Address - Fax:
Practice Address - Street 1:6522 E CARONDELET DR STE B
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-2197
Practice Address - Country:US
Practice Address - Phone:520-609-2159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-18702225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZMT-18702OtherWORKERS COMP