Provider Demographics
NPI:1659312155
Name:FABBIANO, KATHRYN M (PT)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:M
Last Name:FABBIANO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:KATHRYN
Other - Middle Name:M
Other - Last Name:KOLLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5716 LANSDOWNE AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-1528
Mailing Address - Country:US
Mailing Address - Phone:314-416-1707
Mailing Address - Fax:314-416-7184
Practice Address - Street 1:439 S KIRKWOOD RD
Practice Address - Street 2:STE 200
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-6100
Practice Address - Country:US
Practice Address - Phone:314-822-6285
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001018674225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist