Provider Demographics
NPI:1427860543
Name:CHORLTON, KATHRYN MARIE ROTH (LMT, RSMT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MARIE ROTH
Last Name:CHORLTON
Suffix:
Gender:F
Credentials:LMT, RSMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 VERDE VALLEY SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86351-9521
Mailing Address - Country:US
Mailing Address - Phone:970-209-0366
Mailing Address - Fax:
Practice Address - Street 1:70 BELL ROCK PLZ STE G
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86351-9066
Practice Address - Country:US
Practice Address - Phone:970-209-0366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-16878225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty