Basic Information
| Provider Information | |||||||||
| NPI: | 1083669287 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PETKOVSKY | ||||||||
| FirstName: | KATHLEEN | ||||||||
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| Credential: | PT/CHT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2845 S PIEDRA | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852121519 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1355 S HIGLEY RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | HIGLEY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805078080 | ||||||||
| FaxNumber: | 4805078085 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 03/14/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251H1200X | 1205 | AZ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Hand |
No ID Information.