Provider Demographics
NPI:1316482599
Name:KINNEARY, KATHERINE (ATC, LAT, CES, PES)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:KINNEARY
Suffix:
Gender:F
Credentials:ATC, LAT, CES, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 CROMWELL CIR
Mailing Address - Street 2:APT 616
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-6077
Mailing Address - Country:US
Mailing Address - Phone:516-784-6535
Mailing Address - Fax:
Practice Address - Street 1:2425 CROMWELL CIR
Practice Address - Street 2:APT 616
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-6077
Practice Address - Country:US
Practice Address - Phone:516-784-6535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-27
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT68782255A2300X
NY0032272255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer