Provider Demographics
NPI:1831744036
Name:CORREA, KATIA NICOLE (PT)
Entity type:Individual
Prefix:
First Name:KATIA
Middle Name:NICOLE
Last Name:CORREA
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 1:15000 KENSINGTON PARK DR
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-1830
Mailing Address - Country:US
Mailing Address - Phone:657-859-6458
Mailing Address - Fax:657-215-8480
Practice Address - Street 1:15000 KENSINGTON PARK DR
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-1830
Practice Address - Country:US
Practice Address - Phone:657-859-6458
Practice Address - Fax:657-215-8480
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA297002225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty