Provider Demographics
NPI:1700125044
Name:KASS, ELISA KATHRYN (DPT)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:KATHRYN
Last Name:KASS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2217 SUNSET BLVD
Mailing Address - Street 2:SUITE 711
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-4781
Mailing Address - Country:US
Mailing Address - Phone:916-435-3500
Mailing Address - Fax:916-435-3503
Practice Address - Street 1:2217 SUNSET BLVD
Practice Address - Street 2:SUITE 711
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4781
Practice Address - Country:US
Practice Address - Phone:916-435-3500
Practice Address - Fax:916-435-3503
Is Sole Proprietor?:No
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT39717225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist