Provider Demographics
NPI:1629551650
Name:PAPANDREA, KATHLEEN LOUISE (PT, DPT, ATC)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:LOUISE
Last Name:PAPANDREA
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:LOUISE
Other - Last Name:GENETELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, ATC
Mailing Address - Street 1:5 KEARNY DR
Mailing Address - Street 2:
Mailing Address - City:WANTAGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07461-3928
Mailing Address - Country:US
Mailing Address - Phone:862-268-7061
Mailing Address - Fax:
Practice Address - Street 1:2 CHANGEBRIDGE RD BLDG SUITEF
Practice Address - Street 2:
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045-8947
Practice Address - Country:US
Practice Address - Phone:973-917-3134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01822600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist