Provider Demographics
NPI:1619508538
Name:JAMES, KATHERYNE TOBIN (HHP, CMT, MQT)
Entity Type:Individual
Prefix:
First Name:KATHERYNE
Middle Name:TOBIN
Last Name:JAMES
Suffix:
Gender:F
Credentials:HHP, CMT, MQT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 NAGLEE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2012
Mailing Address - Country:US
Mailing Address - Phone:408-234-5902
Mailing Address - Fax:
Practice Address - Street 1:1165 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-3043
Practice Address - Country:US
Practice Address - Phone:408-234-5902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51874225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist