Basic Information
| Provider Information | |||||||||
| NPI: | 1629605803 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROOS | ||||||||
| FirstName: | KATHRYN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 10 | ||||||||
| Address2: | |||||||||
| City: | PINON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 865100010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287259500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2175 STATE ROAD 4 | ||||||||
| Address2: | |||||||||
| City: | PINON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 86510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287259500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2020 | ||||||||
| LastUpdateDate: | 06/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | LPT-31197 | AZ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.