Provider Demographics
NPI:1740414101
Name:DEISINGER, KATHLEEN (MPT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:DEISINGER
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 1:29525 CANWOOD ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4233
Mailing Address - Country:US
Mailing Address - Phone:818-706-1235
Mailing Address - Fax:
Practice Address - Street 1:29525 CANWOOD ST
Practice Address - Street 2:SUITE 202
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4233
Practice Address - Country:US
Practice Address - Phone:818-706-1235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist