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NPI Code Detail

MEDICARE: MISS KATHRYN MARY FIRISIN MSPT, NMD

MEDICARE: MISS KATHRYN MARY FIRISIN MSPT, NMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist006607CT
2225100000XPhysical Therapist28072CA
3225100000XPhysical Therapist8373AZ
4175F00000XNaturopath13-1363AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13749649OTHERAETNA
22V5870OTHERHEALTH NET
39906497OTHERCIGNA
4080006607CT01OTHERBLUE CROSS
5P3551720OTHEROXFORD

General Provider Information

NPI Number : 1568458099
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS KATHRYN MARY FIRISIN MSPT, NMD
Provider Business Mailing Address
First Line : 4630 S LAKESHORE DR
Second Line : #231
City : TEMPE
State : AZ
Zip : 85282-7164
Country : US
Telephone Number : 480-442-2646
Fax Number :
Provider Business Practice Location Address
First Line : 181 MAIN ST
Second Line :
City : MONROE
State : CT
Zip : 06468-1110
Country : US
Telephone Number : 203-445-9843
Fax Number : 203-445-9847
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2005
Last Update Date : 05/07/2013

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Practice Fax: 203-445-9847

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