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General NPI Number Information
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NPI Number | 1265649081
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Entity Type | Individual
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Provider Name | KATHLEEN MARY PROSSER PTA
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Gender | Female
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 333 GELLERT BLVD SUITE 142
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City | DALY CITY
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State | CA
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Zip | 94015-2621
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Country | US
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Telephone | 866-758-4700
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Fax | 650-758-4711
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Provider Business Mailing Address
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Address Line | 486 MCCALL DR
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City | BENICIA
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State | CA
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Zip | 94510-3925
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Country | US
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Telephone | 707-297-6108
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | AT 8343
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License Number State | CA
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