Provider Demographics
NPI:1649896226
Name:COLIE, KATE FOX
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:FOX
Last Name:COLIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12331 RIVERSIDE DR APT 7
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3635
Mailing Address - Country:US
Mailing Address - Phone:818-964-1144
Mailing Address - Fax:
Practice Address - Street 1:11650 RIVERSIDE DR
Practice Address - Street 2:PENTHOUSE 1, SECOND FLOOR
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91602-1093
Practice Address - Country:US
Practice Address - Phone:818-964-1144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28395225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist