Healthcare Provider Details

I. General information

NPI: 1346540887
Provider Name (Legal Business Name): MISS KATHLEEN MARIE MAGNUSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2010
Last Update Date: 12/15/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21042 E ARROW HWY APT. 79
COVINA CA
91724-1400
US

IV. Provider business mailing address

21042 E ARROW HWY APT. 79
COVINA CA
91724-1400
US

V. Phone/Fax

Practice location:
  • Phone: 541-231-3925
  • Fax:
Mailing address:
  • Phone: 541-231-3925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: