Provider Demographics
NPI:1568458099
Name:FIRISIN, KATHRYN MARY (MSPT, NMD)
Entity type:Individual
Prefix:MISS
First Name:KATHRYN
Middle Name:MARY
Last Name:FIRISIN
Suffix:
Gender:F
Credentials:MSPT, NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4630 S LAKESHORE DR
Mailing Address - Street 2:#231
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7164
Mailing Address - Country:US
Mailing Address - Phone:480-442-2646
Mailing Address - Fax:
Practice Address - Street 1:181 MAIN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-1110
Practice Address - Country:US
Practice Address - Phone:203-445-9843
Practice Address - Fax:203-445-9847
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006607225100000X
CA28072225100000X
AZ8373225100000X
AZ13-1363175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
3749649OtherAETNA
2V5870OtherHEALTH NET
9906497OtherCIGNA
080006607CT01OtherBLUE CROSS
P3551720OtherOXFORD
9906497OtherCIGNA