Provider Demographics
NPI:1386069920
Name:WEBB, KATHLEEN SUSAN
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:SUSAN
Last Name:WEBB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ROSALEE PL
Mailing Address - Street 2:
Mailing Address - City:ICKESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17037-9775
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 ROSALEE PL
Practice Address - Street 2:
Practice Address - City:ICKESBURG
Practice Address - State:PA
Practice Address - Zip Code:17037-9775
Practice Address - Country:US
Practice Address - Phone:717-860-4234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI003726225200000X
MDA2642225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant