Provider Demographics
NPI:1124748272
Name:BASA, KATHRINAMAY (PT)
Entity type:Individual
Prefix:
First Name:KATHRINAMAY
Middle Name:
Last Name:BASA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3908 VALLEY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-4872
Mailing Address - Country:US
Mailing Address - Phone:925-417-8005
Mailing Address - Fax:925-417-8881
Practice Address - Street 1:3908 VALLEY AVE STE B
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-4872
Practice Address - Country:US
Practice Address - Phone:925-417-8005
Practice Address - Fax:925-417-8881
Is Sole Proprietor?:No
Enumeration Date:2022-08-30
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT302686225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist