MEDICARE: KATHRYN PAINE PT, DPT

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
1	225100000X	Physical Therapist	295651	CA

General Provider Information

NPI Number	:	1568917136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN PAINE PT, DPT

Provider Business Mailing Address
First Line	:	8720 ANZIO ST APT A
Second Line	:
City	:	FORT IRWIN
State	:	CA
Zip	:	92310-2497
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8720 ANZIO ST APT A
Second Line	:
City	:	FORT IRWIN
State	:	CA
Zip	:	92310-2497
Country	:	US
Telephone Number	:	831-359-2573
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2016
Last Update Date	:	12/07/2020

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