Provider Demographics
NPI:1992949978
Name:MOCK, KATHRYN PEARMAN (LPTA)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:PEARMAN
Last Name:MOCK
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5436 GILLING RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23234-5238
Mailing Address - Country:US
Mailing Address - Phone:804-986-2411
Mailing Address - Fax:
Practice Address - Street 1:46 DIAMOND DR
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-7495
Practice Address - Country:US
Practice Address - Phone:804-861-1324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306001028225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant