Provider Demographics
NPI:1881010064
Name:KARA TATE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:KARA TATE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KARA
Authorized Official - Middle Name:C
Authorized Official - Last Name:KOENITZER TATE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:928-699-9896
Mailing Address - Street 1:2398 N KEYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-7193
Mailing Address - Country:US
Mailing Address - Phone:928-699-9896
Mailing Address - Fax:888-977-1012
Practice Address - Street 1:2398 N KEYSTONE DR
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-7193
Practice Address - Country:US
Practice Address - Phone:928-699-9896
Practice Address - Fax:888-977-1012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-11
Last Update Date:2014-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7710261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy