Healthcare Provider Details

I. General information

NPI: 1568458099
Provider Name (Legal Business Name): KATHRYN MARY FIRISIN MSPT, NMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 05/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 MAIN ST
MONROE CT
06468-1110
US

IV. Provider business mailing address

4630 S LAKESHORE DR #231
TEMPE AZ
85282-7164
US

V. Phone/Fax

Practice location:
  • Phone: 203-445-9843
  • Fax: 203-445-9847
Mailing address:
  • Phone: 480-442-2646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number13-1363
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number006607
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number28072
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8373
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: