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General NPI Number Information
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NPI Number | 1881010064
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Entity Type | Organization
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Legal Business Name | KARA TATE PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 03/11/2014
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Last Update Date | 07/13/2014
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Provider Practice Location Address
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Address Line | 2398 N KEYSTONE DR
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City | FLAGSTAFF
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State | AZ
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Zip | 86004-7193
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Country | US
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Telephone | 928-699-9896
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Fax | 888-977-1012
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Provider Business Mailing Address
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Address Line | 2398 N KEYSTONE DR
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City | FLAGSTAFF
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State | AZ
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Zip | 86004-7193
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Country | US
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Telephone | 928-699-9896
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Fax | 888-977-1012
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | KARA C KOENITZER TATE
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Credential | P.T., D.P.T.
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Telephone | 928-699-9896
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 7710
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License Number State | AZ
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