Provider Demographics
NPI:1598806747
Name:PARRAGUIRRE, KATHLEEN CHRISTINE (PT)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:CHRISTINE
Last Name:PARRAGUIRRE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10447 GARDEN ROSE DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-2806
Mailing Address - Country:US
Mailing Address - Phone:702-371-2979
Mailing Address - Fax:702-655-9049
Practice Address - Street 1:10447 GARDEN ROSE DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-2806
Practice Address - Country:US
Practice Address - Phone:702-371-2979
Practice Address - Fax:702-655-9049
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0389225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV3402442Medicaid
NV32214Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER