Provider Demographics
NPI:1841745544
Name:FRADKIN, KAREN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:FRADKIN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6308 VISTA DEL MAR APT A
Mailing Address - Street 2:
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-7512
Mailing Address - Country:US
Mailing Address - Phone:404-434-7774
Mailing Address - Fax:323-300-2036
Practice Address - Street 1:6308 VISTA DEL MAR APT A
Practice Address - Street 2:
Practice Address - City:PLAYA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90293-7512
Practice Address - Country:US
Practice Address - Phone:404-434-7774
Practice Address - Fax:323-300-2036
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT292931225100000X
PAPT025484225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPT025484OtherPT LICENSE