Healthcare Provider Details

I. General information

NPI: 1366017790
Provider Name (Legal Business Name): KATHERINE ELLEN PECSON P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE LAUDSBERG

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 05/27/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MUIR RD.
MARTINEZ CA
94553
US

IV. Provider business mailing address

2839 JOHNSON AVE.
ALAMEDA CA
94501
US

V. Phone/Fax

Practice location:
  • Phone: 925-372-2000
  • Fax:
Mailing address:
  • Phone: 510-205-3324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT21176
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: