MEDICARE: KATHLEEN PETKOVSKY PT/CHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251H1200X	Hand Physical Therapist	1205	AZ

General Provider Information

NPI Number	:	1083669287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN PETKOVSKY PT/CHT

Provider Business Mailing Address
First Line	:	2845 S PIEDRA
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85212-1519
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1355 S HIGLEY RD
Second Line	:	SUITE 101
City	:	HIGLEY
State	:	AZ
Zip	:	85236
Country	:	US
Telephone Number	:	480-507-8080
Fax Number	:	480-507-8085

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	03/14/2018

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