Provider Demographics
NPI:1891878773
Name:WASOWSKI, KATHLEEN SOEHNGEN (DPT)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:SOEHNGEN
Last Name:WASOWSKI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:KATHY
Other - Middle Name:S
Other - Last Name:WASOWSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:2350 W EL CAMINO REAL FL 2
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-6203
Mailing Address - Country:US
Mailing Address - Phone:408-980-9394
Mailing Address - Fax:
Practice Address - Street 1:401 OLD SAN FRANCISCO RD
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94086-6387
Practice Address - Country:US
Practice Address - Phone:408-523-3060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 109272251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic