Healthcare Provider Details

I. General information

NPI: 1487278032
Provider Name (Legal Business Name): KATHERINE IRENE SHEEHAN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2020
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 S MAIN ST
BISHOP CA
93514-3415
US

IV. Provider business mailing address

17 SUNNY SLOPES RD UNIT A
TOMS PLACE CA
93546-6371
US

V. Phone/Fax

Practice location:
  • Phone: 760-872-2942
  • Fax:
Mailing address:
  • Phone: 510-390-5355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number47925
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: