Provider Demographics
NPI:1922599109
Name:FLEMING, KATHRYN ELIZABETH (ATC)
Entity Type:Individual
Prefix:MISS
First Name:KATHRYN
Middle Name:ELIZABETH
Last Name:FLEMING
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 W BASE LINE ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92411-1650
Mailing Address - Country:US
Mailing Address - Phone:909-383-2663
Mailing Address - Fax:
Practice Address - Street 1:1881 W BASE LINE ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411-1650
Practice Address - Country:US
Practice Address - Phone:909-383-2663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty