Provider Demographics
NPI:1659390391
Name:PIERCE, KATHRYN A (MPT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:A
Last Name:PIERCE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3070
Mailing Address - Street 2:
Mailing Address - City:SHELL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93448-3070
Mailing Address - Country:US
Mailing Address - Phone:805-922-4676
Mailing Address - Fax:
Practice Address - Street 1:2015B S BROADWAY
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-7809
Practice Address - Country:US
Practice Address - Phone:805-922-4676
Practice Address - Fax:805-922-5854
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT22619225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT0226190Medicaid
CAWPT22619AMedicare ID - Type Unspecified