Provider Demographics
NPI:1881788354
Name:KASSAI, KATHRYN (PT)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:
Last Name:KASSAI
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 1:1360 W. SIXTH STREET
Mailing Address - Street 2:#210 NORTH BUILDING
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732
Mailing Address - Country:US
Mailing Address - Phone:310-548-3130
Mailing Address - Fax:310-548-0387
Practice Address - Street 1:1360 W. SIXTH STREET
Practice Address - Street 2:#210 NORTH BUILDING
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732
Practice Address - Country:US
Practice Address - Phone:310-548-3130
Practice Address - Fax:310-548-0387
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12729225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14675Medicare ID - Type UnspecifiedPT PROVIDER