MEDICARE: KATHRYN PEARMAN MOCK LPTA

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	225200000X	Physical Therapy Assistant	2306001028	VA

General Provider Information

NPI Number	:	1992949978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN PEARMAN MOCK LPTA

Provider Business Mailing Address
First Line	:	5436 GILLING RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23234-5238
Country	:	US
Telephone Number	:	804-986-2411
Fax Number	:

Provider Business Practice Location Address
First Line	:	46 DIAMOND DR
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23803-7495
Country	:	US
Telephone Number	:	804-861-1324
Fax Number	:

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

Provider Enumeration Date	:	04/22/2009
Last Update Date	:	04/22/2009

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