Provider Demographics
NPI:1942385018
Name:ZACK, KATHLEEN MCCLAIN (PT)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MCCLAIN
Last Name:ZACK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:201 N COLLEGE DR
Mailing Address - Street 2:STE 203
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4614
Mailing Address - Country:US
Mailing Address - Phone:805-929-3446
Mailing Address - Fax:805-929-3556
Practice Address - Street 1:201 N COLLEGE DR
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4614
Practice Address - Country:US
Practice Address - Phone:805-922-1724
Practice Address - Fax:805-922-2765
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT6529225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic