Healthcare Provider Details

I. General information

NPI: 1942589460
Provider Name (Legal Business Name): KATELYN E GANEV PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATELYN E CARMAN PT

II. Dates (important events)

Enumeration Date: 08/15/2011
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 W ADAMS BLVD
LOS ANGELES CA
90007-2664
US

IV. Provider business mailing address

8302 ESPRESSO DR 100
BAKERSFIELD CA
93312-5687
US

V. Phone/Fax

Practice location:
  • Phone: 213-742-1000
  • Fax:
Mailing address:
  • Phone: 661-377-1700
  • Fax: 661-616-9199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT36850
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: