Provider Demographics
NPI:1255029708
Name:DOROSH, MARY KATHLEEN THERESE (DPT)
Entity type:Individual
Prefix:DR
First Name:MARY KATHLEEN
Middle Name:THERESE
Last Name:DOROSH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:MARY KATHLEEN
Other - Middle Name:THERESE
Other - Last Name:KOSCHNITZKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 48070
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99228-1070
Mailing Address - Country:US
Mailing Address - Phone:509-487-2958
Mailing Address - Fax:
Practice Address - Street 1:6710 N COUNTRY HOMES BLVD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-4337
Practice Address - Country:US
Practice Address - Phone:509-487-2958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT61273896225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist