Provider Demographics
NPI:1972889293
Name:TARQUINIO, KATHRYN MICHELE (PT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MICHELE
Last Name:TARQUINIO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:BADEN
Mailing Address - State:PA
Mailing Address - Zip Code:15005-1207
Mailing Address - Country:US
Mailing Address - Phone:724-869-9032
Mailing Address - Fax:
Practice Address - Street 1:1630 W STATE ST
Practice Address - Street 2:
Practice Address - City:BADEN
Practice Address - State:PA
Practice Address - Zip Code:15005-1207
Practice Address - Country:US
Practice Address - Phone:724-869-9032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT021363225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist