Provider Demographics
NPI:1124241815
Name:OPROMOLLO, KATHLEEN A
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:A
Last Name:OPROMOLLO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:A
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:811 PARK RD
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-2848
Mailing Address - Country:US
Mailing Address - Phone:973-539-9713
Mailing Address - Fax:
Practice Address - Street 1:150 BERGEN ST
Practice Address - Street 2:UNIVERSITY HOSPITAL B403
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2496
Practice Address - Country:US
Practice Address - Phone:973-972-3282
Practice Address - Fax:973-972-5725
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00168800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist