Provider Demographics
NPI:1336988799
Name:MEEUSEN, KATHRYN (PT, DPT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:MEEUSEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2514 GAUL ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-3130
Mailing Address - Country:US
Mailing Address - Phone:586-255-3587
Mailing Address - Fax:
Practice Address - Street 1:3400 ARAMINGO AVE STE 11
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-4531
Practice Address - Country:US
Practice Address - Phone:215-203-1930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-23
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT032298225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist