Provider Demographics
NPI:1649568304
Name:CULLEN, KATHRYN E (DPT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:E
Last Name:CULLEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319A SOUTHBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501-2598
Mailing Address - Country:US
Mailing Address - Phone:508-832-2628
Mailing Address - Fax:508-832-7824
Practice Address - Street 1:30 OAK ST
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-3319
Practice Address - Country:US
Practice Address - Phone:508-389-9912
Practice Address - Fax:508-389-9915
Is Sole Proprietor?:No
Enumeration Date:2011-07-15
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19599225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist