Healthcare Provider Details

I. General information

NPI: 1730302274
Provider Name (Legal Business Name): KATHRYN THERESA GOLLOTTO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN THERESA GOLLOTTO DO

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 HIGHWAY 50
STATELINE NV
89449-9816
US

IV. Provider business mailing address

2170 SOUTH AVE
SOUTH LAKE TAHOE CA
96150-7026
US

V. Phone/Fax

Practice location:
  • Phone: 775-589-8915
  • Fax: 530-999-4311
Mailing address:
  • Phone: 530-541-3420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number25MB08571200
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberOT011173
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: