Provider Demographics
NPI:1356543938
Name:PURDY, KATHY L (ATC)
Entity type:Individual
Prefix:MS
First Name:KATHY
Middle Name:L
Last Name:PURDY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8808 LANDIS AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:SEA ISLE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08243-1065
Mailing Address - Country:US
Mailing Address - Phone:609-465-2161
Mailing Address - Fax:
Practice Address - Street 1:188 CREST HAVEN RD
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-1651
Practice Address - Country:US
Practice Address - Phone:609-465-2161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000782002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer