Provider Demographics
NPI:1700913597
Name:ZAJAC, KATHLEEN M (PT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:ZAJAC
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11471
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12211-0471
Mailing Address - Country:US
Mailing Address - Phone:518-389-1805
Mailing Address - Fax:518-389-1788
Practice Address - Street 1:720 LATTA RD
Practice Address - Street 2:#148
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612-4100
Practice Address - Country:US
Practice Address - Phone:585-752-1444
Practice Address - Fax:866-639-0222
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023030-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY023030-1OtherLICENSE NUMBER