Healthcare Provider Details

I. General information

NPI: 1235050659
Provider Name (Legal Business Name): KATHRYN ANN FABULAR BACANI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 W EMMA AVE APT 71
COEUR D ALENE ID
83814-2598
US

IV. Provider business mailing address

951 W EMMA AVE APT 71
COEUR D ALENE ID
83814-2598
US

V. Phone/Fax

Practice location:
  • Phone: 551-227-5691
  • Fax:
Mailing address:
  • Phone: 551-227-5691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number51354
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: