Provider Demographics
NPI:1720029077
Name:MCELROY, KATHY (PT)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:MCELROY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14650 AVIATION BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-6656
Mailing Address - Country:US
Mailing Address - Phone:310-725-8505
Mailing Address - Fax:310-725-8509
Practice Address - Street 1:14650 AVIATION BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-6656
Practice Address - Country:US
Practice Address - Phone:310-725-8505
Practice Address - Fax:310-725-8509
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12337225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT12337BMedicare ID - Type Unspecified