Provider Demographics
NPI:1720251093
Name:KOENITZER TATE, KARA CHRISTINE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:CHRISTINE
Last Name:KOENITZER TATE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:C
Other - Last Name:TATE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:601 E PICCADILLY DR APT 407
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-5978
Mailing Address - Country:US
Mailing Address - Phone:928-707-4515
Mailing Address - Fax:888-701-8022
Practice Address - Street 1:1253 N FOX HILL RD
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-7881
Practice Address - Country:US
Practice Address - Phone:928-707-4515
Practice Address - Fax:888-701-8022
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7710225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist