1275745556 NPI number — KATHLEEN WHALEN WEISBLATT PT

Table of content: KATHLEEN WHALEN WEISBLATT PT (NPI 1275745556)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275745556 NPI number — KATHLEEN WHALEN WEISBLATT PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEISBLATT
Provider First Name:
KATHLEEN
Provider Middle Name:
WHALEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275745556
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
85 LAKEWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARWICH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02645
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-430-1660
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4730 STATE HIGHWAY 6
Provider Second Line Business Practice Location Address:
CAPE COD HOSPITAL REHABILITATION AT WILLYS GYM
Provider Business Practice Location Address City Name:
EASTHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-247-9775
Provider Business Practice Location Address Fax Number:
508-247-9778
Provider Enumeration Date:
05/07/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  9570 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)