Provider Demographics
NPI:1851579460
Name:KITELEY, KAREN K (PT PHYSICAL THERAPY)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:K
Last Name:KITELEY
Suffix:
Gender:F
Credentials:PT PHYSICAL THERAPY
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:14592 PALMDALE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392
Mailing Address - Country:US
Mailing Address - Phone:760-245-3769
Mailing Address - Fax:760-245-5145
Practice Address - Street 1:14592 PALMDALE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392
Practice Address - Country:US
Practice Address - Phone:760-245-3769
Practice Address - Fax:760-245-5145
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7048225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PT70480Medicare PIN