Provider Demographics
NPI:1730302274
Name:GOLLOTTO, KATHRYN THERESA (DO)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:THERESA
Last Name:GOLLOTTO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:KATHRYN
Other - Middle Name:THERESA
Other - Last Name:GOLLOTTO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:600 SOMERDALE RD
Mailing Address - Street 2:SUITE 113
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-1858
Mailing Address - Country:US
Mailing Address - Phone:856-795-1945
Mailing Address - Fax:
Practice Address - Street 1:600 SOMERDALE RD
Practice Address - Street 2:SUITE 113
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-1858
Practice Address - Country:US
Practice Address - Phone:856-795-1945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT011173208100000X
NJ25MB085712002081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MB08571200OtherLICENSE
PAOT011173OtherTRAINING LICENSE