Provider Demographics
NPI:1104908987
Name:KABAT, JODI SUE (MPT)
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:SUE
Last Name:KABAT
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5161 LONE TREE WAY
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-8689
Mailing Address - Country:US
Mailing Address - Phone:925-522-8000
Mailing Address - Fax:925-522-8000
Practice Address - Street 1:5161 LONE TREE WAY
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531
Practice Address - Country:US
Practice Address - Phone:925-522-8000
Practice Address - Fax:925-522-8008
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28080225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist