Healthcare Provider Details

I. General information

NPI: 1295032290
Provider Name (Legal Business Name): KATHERINE MARIE ADDIS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2011
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6915 FLANDERS DR STE D
SAN DIEGO CA
92121-2987
US

IV. Provider business mailing address

6915 FLANDERS DR STE D
SAN DIEGO CA
92121-2987
US

V. Phone/Fax

Practice location:
  • Phone: 858-265-7727
  • Fax:
Mailing address:
  • Phone: 858-265-7727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number37610
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: