Provider Demographics
NPI:1770092934
Name:WITHROW, KATHLEEN (RPT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:WITHROW
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:SCHOONOVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:7101 MAJESTIC CT
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-8553
Mailing Address - Country:US
Mailing Address - Phone:1707-363-3113
Mailing Address - Fax:
Practice Address - Street 1:7101 MAJESTIC CT
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-8553
Practice Address - Country:US
Practice Address - Phone:1707-363-3113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-20
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT15906208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation