Provider Demographics
NPI:1386124949
Name:ABLA, KATHERINE JOY SAN JUAN
Entity type:Individual
Prefix:
First Name:KATHERINE JOY
Middle Name:SAN JUAN
Last Name:ABLA
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 1:4005 PARIS MEADOWS CT
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-1126
Mailing Address - Country:US
Mailing Address - Phone:954-706-3356
Mailing Address - Fax:
Practice Address - Street 1:4005 PARIS MEADOWS CT
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-1126
Practice Address - Country:US
Practice Address - Phone:954-706-3356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3890225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist