Healthcare Provider Details

I. General information

NPI: 1538434253
Provider Name (Legal Business Name): LAURA KITLAS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2012
Last Update Date: 04/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 DIABLO RD STE 110
DANVILLE CA
94526-3409
US

IV. Provider business mailing address

315 DIABLO RD STE 110
DANVILLE CA
94526-3409
US

V. Phone/Fax

Practice location:
  • Phone: 925-855-8353
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number38384
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: