MEDICARE: MRS. KATHRYN COOLEY NESBIT PT

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	2251P0200X	Pediatric Physical Therapist	2305002111	VA

General Provider Information

NPI Number	:	1932319027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHRYN COOLEY NESBIT PT

Provider Business Mailing Address
First Line	:	1262 48TH AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-1013
Country	:	US
Telephone Number	:	540-539-9115
Fax Number	:	540-539-9115

Provider Business Practice Location Address
First Line	:	1975 4TH ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94143-2351
Country	:	US
Telephone Number	:	415-514-4028
Fax Number	:	415-514-4028

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	11/12/2025

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