Provider Demographics
NPI:1013468552
Name:BALGEMAN, KATHRYN MARY (PT, DPT, CLT)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:MARY
Last Name:BALGEMAN
Suffix:
Gender:F
Credentials:PT, DPT, CLT
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:MARY
Other - Last Name:DOWDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, CLT
Mailing Address - Street 1:2363 E DESERT TRUMPET RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-9167
Mailing Address - Country:US
Mailing Address - Phone:480-485-6574
Mailing Address - Fax:
Practice Address - Street 1:10429 S 51ST ST STE 206
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-5237
Practice Address - Country:US
Practice Address - Phone:480-485-6574
Practice Address - Fax:866-388-7823
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-19
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0014310225100000X
AZLPT-30649225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist