Healthcare Provider Details

I. General information

NPI: 1811850928
Provider Name (Legal Business Name): KATHRYN MULLEN MECHTLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3752 ROUTE 9G
RHINEBECK NY
12572-1173
US

IV. Provider business mailing address

63 WHALESBACK RD
RED HOOK NY
12571-3301
US

V. Phone/Fax

Practice location:
  • Phone: 845-876-8229
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number055305-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: